Refractory chylous ascites revealing follicular lymphoma: A case report

INTRODUCTION AND IMPORTANCE

Chylous ascites is an uncommon form of ascites characterized by milky fluid rich in triglycerides. It is associated with poor lymphatic drainage. We report a case of chylous ascites revealing a follicular lymphoma.

CASE PRESENTATION

A 73-year-old man presented with a 6-month history of abdominal distension attributed to a chylous ascitis. The thoraco-abdomino-pelvic CT scan revealed voluminous intra- and retroperitoneal mass inseparable from the duodeno-pancreatic block and encompassing the mesenteric vessels, inferior vena cava and renal vessels; abundant ascites and multiple mediastinal, coeliomesenteric, retroperitoneal, iliac and inguinal adenomegalia. The diagnosis of follicular lymphoma was retained through a radio-guided biopsy of the retroperitoneal mass. The patient had weekly paracentesis and immuno-chemotherapy. The course was unfavorable, marked by infection of the ascites fluid after two cycles of immuno-chemotherapy. Our patient developed severe sepsis and died.

CLINICAL DISCUSSION

Chylous ascites in conjunction with follicular lymphoma is an exceptional presentation. The pathophysiological mechanism is an impediment to subdiaphragmatic lymphatic drainage caused by external pressure, leading to leakage of dilated subserosal lymphatic ducts into the peritoneal cavity. Histological confirmation is fundamental to manage chylous ascites resulting from lymphomas.

CONCLUSION

Chylous ascites revealing lymphoma is a unique condition. The key to management is the treatment of the underlying etiology.

Management of a hepatic hydatid cyst ruptured into the retroperitoneum and the abdominal wall muscles: A case report

Introduction. Hydatid disease is a zoonosis caused by the tapeworm Echinococcus granulosus. The liver is the most commonly involved organ, followed by lungs. The most common complications of hepatic hydatid cyst are rupture into the biliary tract and secondary bacterial infection. However, rupture into the retroperitoneum and the abdominal wall muscles is exceptional. Case presentation. We describe an unusual case of a 27-year-old female who was referred to our department for right flank pain for four months. Abdominal ultrasound and CT scan revealed a huge hydatid cyst in liver segment VI fistulizing to the retroperitoneum and the lateral and posterior abdominal wall muscles, causing anterior displacement of the right kidney, with two other cysts in segment II and VIII. Surgery was performed associated with perioperative antiparasitic chemotherapy. The cysts were unroofed and a resection of the protruding domes was performed. The hydatid material in the retroperitoneum and the muscles were completely evacuated by aspiration. Follow-up showed no recurrence. Discussion. Hepatic hydatid cyst rupture usually occurs into biliary tract, pleural cavity, bronchial tree and intraperitoneal cavity. Rupture into the retroperitoneum and the lateral and posterior abdominal wall muscles is exceptional. To our knowledge, this complication has never been documented before. The hydatid disease may involve insidiously for a long time to lead to such a complication. Surgery was inevitable in our case. It allowed to treat both the hydatid cyst and its complication. Conclusions. A rupture into the retroperitoneum and the abdominal wall muscles as a complication of a liver hydatid cyst is exceptional. In this presentation, we noticed that hydatid cysts can reach an extremely large size while remaining for a long time asymptomatic. We aim to highlight the significance of preventive measures and public health education to fight against the hydatid disease in endemic areas.

[Giant pelvic lipoma mimicking a liposarcoma]

Le lipome géant (LG) est une entité rare, de siège ubiquitaire. Sa localisation pelvienne est rare avec moins de 10 cas rapportés dans la littérature. Le principal diagnostic différentiel est le liposarcome bien différencié de type lipoma like. Nous rapportons le cas d'une patiente âgée de 50 ans, qui avait consulté pour une gêne pelvienne depuis 3 mois avec l'apparition d'une masse ischio rectale gauche. Le scanner abdomino-pelvien avait montré une masse lipomateuse homogène hypo dense en situation pré sacrée de 10 x18 cm. A l'imagerie par résonance magnétique (IRM), cette masse était hyper intense en pondération T1 et T2 avec des cloisons fines et atteignait la hauteur de la 2^ème vertèbre sacrée. Une exérèse totale a été réalisée par une double voie abdominale et périnéale sans rupture de sa capsule. L'examen anatomopathologique a confirmé le diagnostic de LG. Le but de ce travail était de rapporter un nouveau cas de LG pelvien pré sacré qui se prolonge dans la fosse ischio rectale gauche.

[Spontaneous rupture of hydatid cyst of liver in the peritoneal cavity with intact proligerous membrane: about a case and literature review]

Rupture of hydatid cyst of liver with intact proligerous membrane is rare. We report the case of a 63 year-old female patient presenting with right hypocondrium pain without fever or jaundice. Diagnostic imaging examination showed hydatid cyst in segment IV of liver associated with pelvic cystic lesion measuring 12 cm x 06 cm. Surgical exploration revealed ruptured unilocular hydatid cyst of the liver with intact proligerous membrane and free in the peritoneal cavity. This study aims to report a new case of intraperitoneal rupture of hydatid cyst of liver with intact proligerous membrane and to highlight the diagnostic and therapeutic difficulties due to this complication.