Hydatid disease of the pelvis

Clinical Pattern of Pediatric Hydatid Disease

Context

Literature regarding hydatid disease in children is sparse.

Aims

To highlight the peculiarities in the clinical pattern of pediatric hydatid disease (PHD).

Settings and Design/Materials and Methods

Data were collected retrospectively from all children aged <18 years who presented to our tertiary care institute from July 2021 to June 2023 with hydatid disease involving any organ.

Statistical Analysis Used

Simple statistical analysis involving sums, means, averages, and percentages.

Results

Four of the 10 cases (40%) involved the lung, while only 2 (20%) involved the liver. There were five females and four males with an age range of 2-17 years. Four of the cases had primary extrahepatic extrapulmonary hydatid disease (40%), two involving the pancreas, one in the rectouterine pouch, and one intracranial.

Conclusions

The clinical pattern of PHD is different from that of adults. Pulmonary echinococcosis is more common than hepatic involvement. Primary extrahepatic extrapulmonary hydatid disease is also more common in children than previously thought. A cystic lesion anywhere in a child warrants a differential of hydatid disease.

Primary Pelvic Hydatid Cyst in Adolescent Female

Primary pelvic hydatid cyst occurs through hematogenous or lymphatic route. Adolescent female presented with complaints of suprapubic discomfort and constipation. Imaging revealed a cystic lesion in pouch of Douglas and removed surgically. This case emphasizes considering hydatid disease as a differential diagnosis of cystic pelvic mass, especially in the endemic regions.

Cystic lesions of the retrorectal space

Cysts of the retrorectal space comprise a heterogeneous group of rare lesions. Most develop from embryological remnants and include tailgut cysts, dermoid cysts, rectal duplication cysts, anal canal duplication cysts, sacrococcygeal teratomas and anterior meningocoele. Tailgut cyst is the most common cyst of developmental origin, usually presenting as a multilocular cystic mass with mucoid content and lined by multiple epithelial types. Compared with tailgut cysts, rectal duplication cysts display all layers of the large bowel wall including a well-defined muscularis propria. Retrorectal cysts of non-developmental origin are far less common and represent lesions that either infrequently involve the retrorectal space or undergo extensive cystic change. This review provides an overview of the various histological types of cystic lesions of the retrorectal space, divided into cysts of developmental origin and those of non-developmental origin. A practical pathological and multidisciplinary approach to diagnosing these lesions is presented.

Disseminated hydatidosis with rare presentation as “cystovesical fistula”

Disseminated hydatidosis is a rare disease and may involve any organ of the human body. In this case, an elderly female got infected by Echinococcus and presented with disseminated disease. A fistulous communication developed between one of the hydatid cysts present in the retrovesical region and the bladder, because of which the patient presented with hydatiduria.

Acute Urinary Retention due to Primary Pelvic Hydatid Cyst: A Rare Case Report and Literature Review

Causes of urinary retention in old men include benign prostatic hyperplasia, prostatitis, prostate cancer, Scarring of the urethra or bladder neck as a result of injury or surgery, use of certain medicines particularly NSAIDs and opioid analgesics, constipation and neurogenic bladder. When the above common causes are not quite obvious by clinical examination and relevant investigations, then it is necessary to think of other rare diseases. It is with the above in our mind that a case of bladder outflow obstruction due to a large primary retrovesical hydatid cyst is herein reported in a 58-year-old man. Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) scan of the abdomen and pelvis of the patient revealed a large, multilocular, nonenhancing, cystic lesion in the rectovesical pouch having typical cartwheel appearance without any other intraabdominal organ involvement. These typical radiological characteristics led us to suspect the presence of a hydatid cyst. He underwent exploratory laparotomy where cystopericycstectomy was done. Pre-operative and post-operative albendazole prophylaxis was also given. In conclusion, hydatid cyst should always be considered in the differential diagnosis of pelvic cystic masses, specially in endemic regions.

Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy

Hydatid disease of the urinary tract is uncommon, accounting for only 2-3% of cases. There are very few reported cases in the literature of pelvic hydatid cysts causing obstructive uropathy and renal failure. We report a case of pelvic hydatid cyst in a patient presenting with urinary retention and secondary complete atrophy of one kidney. The patient was treated with surgical excision of this large retrovesical cyst, along with a simple left nephroureterectomy, with rapid improvement of symptoms. Hydatid disease should be taken into consideration in the differential diagnosis of a cystic mass in any anatomic localization, especially in patients from endemic areas.

Echinococcosis involving the liver, retrovesical and seminal vesicle presented with syncope

Hydatid disease of the urogenital system, especially of the retroperitoneum and seminal vesicles, is a very rare condition. We report a case of hydatid disease located in the liver, retrovesical region and seminal vesicle that was diagnosed incidentally while investigating the etiology of syncope. Transabdominal and transrectal ultrasonography revealed hypoecoic multicystic masses which had thin septations and walls in the liver, retrovesical region and seminal vesicle. Abdominal computed tomography examination showed multicystic low attenuation masses in the same region. Pelvic magnetic resonance image findings revealed multiple cystic masses in the retrovesical region and the right seminal vesicle. In conclusion, the diagnosis of hydatid disease should be kept in mind with patients who have cystic lesions in seminal vesicle and retrovesical region.

Echinococcal cyst of the seminal vesicles: a case-report and literature review

Solitary echinococcal cysts of the seminal vesicles are very uncommon. The use of ultrasonography, computed tomography and magnetic resonance imaging aids considerably in the differential diagnosis. Surgical removal of pelvic echinococcal cysts should be performed with great caution to avoid accidental puncture and parasite spillage in the retroperitoneal space. We report on a case of a male patient presenting with urinary retention owing to a large hydatid cyst of the seminal vesicles. The literature regarding this rare clinical entity is also reviewed.

Six cases of Lactobacillus bacteraemia: identification of organisms and antibiotic susceptibility and therapy

Six cases of bacteraemia in hospitalized patients, 5 with a depressed immune status, were caused by lactobacilli. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins and API 50 CH carbohydrate patterns assigned the causative agents to the species Lactobacillus rhamnosus, Lactobacillus curvatus, Lactobacillus delbrueckii subsp. lactis and Lactobacillus paracasei subsp. paracasei.

A case of hydatid disease: urinary retention due to an isolated retrovesical hydatid cyst in a boy

A 13-y-old male patient presented with acute urinary retention and bilateral lumbar pain. The routine laboratory tests were normal. Casoni's skin test and indirect haemagglutination assay (1/160) were positive. Evidence of hydatid disease was found during surgery. Histopathological examination confirmed hydatid disease in the surgical specimens.

Pelvic echinococcus mimicking multicystic ovary

An unusual case of pelvic echinococcus cyst is presented, appearing initially on transvaginal ultrasound as a pelvic mass mimicking a multicystic ovary. A similar mass in the liver raised preoperatively the suspicion of echinococcosis, making an open surgical procedure preferable to laparoscopy. Diagnosis was confirmed pathologically after removal of the cyst. Though their location in the pelvis is rare, echinococcal cysts should be considered in the differential diagnosis of pelvic masses, especially in patients from endemic areas. Evaluation of previous medical history and current symptoms, together with the ultrasonographic findings, is important for correct diagnosis and appropriate management.

Retrovesical echinococcal cyst causing renal failure and nocturnal enuresis in a child

Although retrovesical hydatid cysts are observed in adulthood albeit very rarely, to our knowledge there is no case reported in childhood. In the current case, a huge retrovesical hydatid cyst caused obstructive uropathy, polydipsia, and secondary nocturnal enuresis in a child. Because the retrovesical hydatid cyst was firmly adherent to the neighboring structures, partial cystectomy could be performed. Perioperative and postoperative complications did not occur, and the symptoms relieved in the early postoperative period.

[Pelvic hydatid yst: apropos of 8 cases]

The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.

An unusual cause of urinary retention: a primary retrovesical echinococcal cyst

We present a patient with symptoms of frequency, a mild decrease in urinary stream, and urinary retention due to a huge hydatid cyst located in the retrovesical region. Chest radiography and abdominal computed tomography did not reveal any other site of hydatid disease involvement. Since the cyst was in intimate contact with the seminal vesicles and the vasa deferentia, part of the hydatid sac wall adherent to these structures was left behind during the surgical excision. The patient was free of voiding symptoms, and no other episode of urinary retention had occurred at 6 months of follow-up. Pelvic computed tomography did not reveal recurrence of hydatid disease at 6 months postoperatively.

Isolated retrovesical and extrarenal retroperitoneal hydatidosis: clinical study of 10 cases and literature review

PURPOSE

Isolated extrarenal retroperitoneal echinococcal cyst is a rare manifestation of hydatid disease. We review the clinical findings of a series of isolated retrovesical and retroperitoneal hydatid cysts in an endemic area, with special emphasis on diagnostic pitfalls.

MATERIALS AND METHODS

A retrospective 15-year review in a rural area of central Spain (600,000 population), with a global incidence of hydatidosis of 10 new cases per 100,000 population per year, revealed 10 patients (0.1 cases per 100,000 per year) with surgically treated primary extrarenal retroperitoneal echinococcosis and absence of other hydatid cysts in any organ. Clinical, radiological and laboratory data are analyzed. The literature of the last 15 years on hydatid disease with a primary retroperitoneal and retrovesical location is reviewed.

RESULTS

A total of 42 cases of isolated retrovesical (25) and retroperitoneal (17) hydatidosis was compiled. Male predominance of 2.5:1 was noted and age ranged from 8 to 79 years (mean 42.2 +/- 5.4). The most frequent presentation was a palpable mass in 29% of the cases followed by flank pain in 24%, frequency in 17% and urinary retention in 14% of the cases. Hydatiduria of the urinary tract was present in 9.5% of the cases. Different serological investigations were performed in 45% of the cases with positive results in 68%. The lesion had been surgically removed in all cases. Therapy and followup of each patient were analyzed.

CONCLUSIONS

An isolated retrovesical, retroperitoneal or even retrocrural cyst can be the unique manifestation of hydatid disease. Although difficult, preoperative diagnosis is desirable for the selection of a surgical approach and prevention of allergic reactions and operative spillage. A diagnostic algorithm and several therapeutic guidelines are proposed.

Primary pelvic hydatid cyst presenting with obstructive uropathy and renal failure

Primary pelvic hydatid cyst is a rare entity. Pelvic hydatid cysts usually present with pressure symptoms involving adjacent organs (bladder and rectum usually). A case of primary pelvic hydatid cyst presenting with obstructive uropathy leading to chronic renal failure is presented. A combination of preoperative albendazole therapy of 1.2 g/day for 8-12 weeks and surgical excision were effective in alleviating the symptoms and improving the renal function.

Müllerian duct cyst: ultrasonographic and computed tomographic spectrum

A Müllerian duct cyst (MDC) is the persistent remnant of the Müllerian duct. Reports of symptomatic cases are rare, signs and symptoms include perineal pain, dysuria, infertility, hematuria and genital inflammation. The prevalence of MDC has been previously reported as 4% of newborns and 1% in adult males. Herein we report six cases encountered in the past year. Our detection percentage was 1% and is compatible with the reported values. The imaging evaluation of symptomatic and asymptomatic patients with MDC is discussed as well as the apparent discrepancy between the number of previously reported cases and the reported prevalence.