Primary giant hydatid cyst of the retroperitoneum: Diagnosis and therapeutic approaches

INTRODUCTION AND IMPORTANCE

Primary hydatid cyst of the retroperitoneum is an exceedingly rare manifestation of hydatid disease. Diagnosis proves challenging due to nonspecific symptoms, and the condition is typically not suspected when facing a retroperitoneal cystic mass, necessitating awareness among clinicians and surgeons, particularly in endemic regions.

CASE PRESENTATION

A 45-year-old male with a three-month history of progressive abdominal enlargement and pain. Living in a rural area, he exhibited a 30 cm, well-defined retroperitoneal cyst, with no guarding confirmed by CT-scan, with characteristic daughter cysts. The diagnosis of primary retroperitoneal hydatid cyst was supported by positive hydatid serology and eosinophilia. Surgical intervention was crucial, and a complete pericystectomy, with 4 cm of pericyst on the aorta due to safety concerns, was performed after three months of preoperative albendazole-based treatment. The postoperative course was uneventful, and a two-year follow-up revealed no recurrence.

CLINICAL DISCUSSION

The prevalence of hydatid disease in North Africa is high, yet retroperitoneal cases are rare. The difficulty to diagnosis retroperitoneal masses, underscores the importance of precise patient evaluation and detailed imaging analysis. Percutaneous puncture is contraindicated due to the risk of dissemination, highlighting even more the significance of accurate preoperative diagnosis. Surgery, coupled with Albendazole treatment, remains the gold-standard, associated with meticulous intraoperative precautions to prevent disease dissemination.

CONCLUSION

Primary retroperitoneal hydatid cyst is rare. Diagnosis is difficult. Precise determination of patient's background and detailed analysis of imaging findings are mandatory. Percutaneous puncture is forbidden as it leads to disease spreading or even anaphylactic shock. Surgical excision is the gold-standard.

A 4-Year-Old Child with a Giant Cerebral Hydatid Cyst: A Case Report

Echinococcosis is the most common cestode infection globally caused by the Echinococcus species. The most common organ involvement is the lungs and liver, but other organs can be rarely involved. Here, we present a case with a giant cerebral hydatid cyst. A 4-year-old boy presented with abnormal gait and walking at Marmara University School of Medicine Pendik Training and Research Hospital, Istanbul, Türkiye in September 2022. Cranial magnetic resonance imaging showed a cyst of 13 cm in diameter. The cyst was enucleated successfully with no rupture. Oral albendazole therapy was started. There was no eosinophilia, and the echinococcal indirect hemagglutination test was negative. Ultrasonography detected an anechoic cystic lesion in the liver. He was evaluated for deep-organ involvement; however, no cysts were detected in other organs. The histopathological examination was compatible with a hydatid cyst. Although intracranial hydatid disease in children is rare, it should be considered among the differential diagnoses in patients with neurological symptoms, especially in endemic regions.

Gossypiboma mimicking a hydatid cyst: A case report

INTRODUCTION

Retained foreign bodies have become very rare in countries where the safety rules in the operating theater are very rigorous and follow precise guidelines. Maintaining awareness of this issue among surgeons and radiologists is of paramount importance to minimize avoidable morbidity and facilitate the selection of the most suitable therapeutic strategy. This consideration is particularly relevant in the differential diagnosis of hydatid cysts. This study describes a case of intra-abdominal gossypiboma, which mimicked hydatid cyst on preoperative assessment.

CASE PRESENTATION

We report the case of a 63-year-old female who was referred to our department for the management of a hepatic hydatid cyst. She has history of open cholecystectomy and oophorocystectomy. During the intervention, we discovered a 10 cm mass located in the interhepatogastric region. Complete resection of the mass was performed, and pathology results were compatible with a piece of gauze surrounded by reactive changes (gossypiboma).

DISCUSSION

Gossypiboma is undeniably a source of concern for surgeons. It's a genuine and serious surgical complication which can potentially arise from any type of surgery and may manifest with diverse complaints. However, it is crucial to emphasize that this complication is preventable with the primary preventive measure being meticulous counting of surgical materials during the procedure.

CONCLUSION

The potential embarrassment experienced by the surgeon and the significant legal consequences associated with this iatrogenic complication are substantial. Hence, it becomes imperative to adopt all requisite preventive measures to avert such incidents, as there is no excuse that can justify their occurrence.

Central Pericystectomy for Hydatid Cyst Treatment

BACKGROUND

Compared to open resection for hepatic hydatid cysts, a laparoscopic approach may combine the benefit of reduced morbidity with complete cyst removal. Nonetheless, intraoperative cyst rupture during a laparoscopic approach due to reduced tactile feedback is a valid concern.^1-3 Today, the laparoscopic experience remains limited even in high incidence regions.⁴ Here, a structured approach to laparoscopic pericystectomy is demonstrated.

PATIENT

A 37-year-old male from Uruguay presents with worsening abdominal pain, nausea, and vomiting. A 4-phase liver CT shows a large complex liver cyst (8.8 × 8.2 × 11.3 cm), encompassing the left hepatic lobe while abutting right hepatic vein (RHV), anterior fissure vein (AFV) and inferior vena cava (IVC). Further, the cyst causes mass effect on the hepatic vein vasculature. CT appearance is consistent with a large hydatid cyst with distorted hepatic anatomy resulting in compensatory hypertrophy of segments II, VI and VII. Appropriate institutional review board (IRB) and inform consent was obtained.

TECHNIQUE

Following neoadjuvant albendazole for 4 weeks to minimize any effects in case of inadvertent cyst spillage, the patient tested negative for echinococcal antibody. For surgical planning, the patient's anatomy was modeled to optimize the understanding of the complex spatial relationship between cyst, portal pedicle and hepatic veins. Further, port sites were preoperatively modelled to optimize port placement in the context of the altered anatomy from compensatory hepatic hypertrophy. During surgery, with the patient in a modified French position, the liver was completely mobilized. Then, a parenchymal transection plane was developed guided by RHV, AFV and IVC, while biliary radicals entering directly into the cyst were controlled individually. The complex transection plane resulted in preservation of the unaffected liver segments I, II, VI and VII.

CONCLUSION

The multimodal approach demonstrated here included pretreatment with albendazole followed by safe laparoscopic pericystectomy. In the preoperative setting, albendazole can reduce the risk of recurrence if spillage occurs during surgery. In inoperable patients, it has been previously shown to be an effective monotherapy for small (< 5 cm) CE1 and CE3a cysts.⁵ For preoperative planning, an automated image reconstruction software (Fujifilm Synapse 3D) is used. The software creates a 3D model of the liver segmentation and vessels from contrast-enhanced CT and MR images. In addition to modelling the liver, port placement in relation to the liver is being simulated prior to surgery to optimize port placement at the time of surgery. During the case, the parenchymal transection is guided by RHV, AFV and IVC. The common postoperative complication of persistent biliary leakage was avoided by controlling each biliary radicals entering the cyst from the liver parenchyma. Biliary leaks are a common complication and have been positively correlated with the cyst diameter (~ 79% of cysts with diameter of 7.5 cm or greater have cysto-biliary fistula).⁶ In this context, indocyanine green may help to identify relevant biliary radicals entering the cyst or aid in recognizing bile leaks. If the stepwise approach described here is followed, minimally invasive pericystectomy represents a safe alternative to open surgery, harnessing the advantages of minimal risk of recurrence due to complete cyst removal and low morbidity.

Primary cardiac hydatic cyst with multiple locations: an unusual case of chest pain

Cardiac echinococcosis is a rare manifestation of Echinococcus infection, affecting 0.5-2% of the patients. Since it may be a life-threatening condition, surgical treatment should be always considered. Herein, here we present a case of a 66-year-old male with chest pain. Subsequent exams confirmed the diagnosis of multiple cardiac hydatic cysts. The patient initiated treatment with albendazole and was submitted to a surgical resection with cardiopulmonary bypass. A complete surgical resection was achieved, and patient remains asymptomatic without disease signs of recurrence on imaging exams. We highlight the necessity of cardiac screening in echinococcosis cases and the surgical management in this case.

Abdominal effusion revealing an exophytic hydatid cyst of the liver has developed under mesocolic

The hydatid cyst of the liver is a parasitic disease due to the development of echinococcosis granulosus. It is common in livestock regions in developing countries but is gaining interest in the West due to migratory flows. If it remains a benign and asymptomatic affection for a long time, its natural evolution is often enamelled of complication which can put at the risk of vital prognosis. Diagnosis and staging are based on morphological examinations, including ultrasound and CT scan. The hydatid serology retains a place especially for the detection of recurrence after hydatid cyst of the liver surgery. In addition to surgery considered up to as the radical treatment of choice, other techniques have appeared in the therapeutic arsenal in combination with oral treatment with albendazol for uncomplicated cases thus reducing the morbidity of surgery. We report a case of giant hydatid cyst associated with exophytic liver development under mesocolic associated with a peritoneal hydatidosis.

Case Report: Isolated Renal Hydatid Cyst in a Boy

Hydatic cyst is a crucial and prevalent parasitic disease in the developing countries in the Mediterranean region. Its diagnosis is sometimes problematic because of non-specific complaints and unavailability of any positive results in a routine laboratory analysis. Isolated renal hydatid cysts are very rare. In this study, a primary left renal hydatid cyst which was found in a 12-year-old boy was presented. He was referred by another hospital to our department with a flank pain and cystic mass in left kidney. Indirect haemagglutination test (IHA) for Echinococcus was negative. Nephrectomy was performed with the diagnosis of renal cyst hydatic. Renal cyst hydatid may present with various clinical findings ranging from asymptomatic clinical course to total loss in renal function. It will be beneficial to consider a renal hydatid cyst in patients with blurred flank pain, even if IHA is negative.

Musculoskeletal Hydatid Cysts Resembling Tumors: A Report of Five Cases

Although challenges in treatment of musculoskeletal hydatid cysts (HC) lesions have been documented, data regarding the musculoskeletal HC lesions resembling tumor is scarce. This paper presented 5 patients (3 males, 2 females) with a mean age of 41.6 years with tumor-like lesions of HC. Three of them had left ilium and acetabulum involvement, one involved left femur, and one involved left thigh muscle compartments. Pain was the main symptom and was seen in all patients. Clinical examination, radiologic evaluation, and histologic analysis were performed for diagnosis. Patients were treated through different surgical options, including simple debridement, bone cement filling with or without internal fixation, hip arthrodesis, reconstruction using hemipelvic replantation with femoral prosthesis and distal femur endoprosthetic replacement. After surgery, the operation region was washed by 20% hypertonic saline, and debridement was performed carefully without contamination. All patients received albendazole treatment. Cases were followed up 1 to 9 years for the recurrence. Walking difficulty and pain were the main symptoms during the follow-up. One patient was symptom-free. A reoccurrence in the perioperative soft tissue was detected in only one patient and control visits with antihelmintic treatment were recommended. We would like to emphasize that HC should be kept in mind for the differential diagnosis of the cystic or tumoral lesions of the musculoskeletal system, particularly in the endemic regions. Prompt diagnosis is of paramount importance for preventing destruction and complications.

A Cystic Mass does not Always Mean Hydatid Cyst in Endemic Areas

Within the medical community, there is a tendency to describe all cystic lesions in the liver and lungs as Hydatid disease (HD) in areas with HD endemics. This approach may sometimes cause a misdiagnosis. We have three cases with children aged between seven, seven and ten year old, all of whom had been diagnosed, via radiologic imaging, with HD cysts and started on treatment without confirmation. The true diagnoses of these cases were undifferentiated embryonal sarcoma (UES) in two and oesophageal duplication in one case, respectively. The indirect haemagglutination assays (IHA) were obtained in two of them. Although their results were negative, albendazole treatment was started in all cases. Confirmatory tests should be run in dubious cases. An IHA test can aid the diagnosis, although its effectiveness is limited. The possibility of false positive and negative results always exists, especially in lung cysts. A percutanous biopsy is strongly advised for differential diagnosis.

[Hydatic cyst of the fallopian tube]

Hydatic cyst of the Fallopian tube is an exceptional localization, the diagnosis of which is frequently confirmed preoperatively. A 44-year-old woman was addressed for pelvic mass with fortuitous discovery. The diagnosis preoperatively confirmed by the extemporaneous histological study was hydatic cyst of the Fallopian tube. Salpingectomy was required. The pelvic hydatic cyst, particularly in the Fallopian tube, is a rare complaint. Clinics and biology were very important for diagnosis but only anatomopathology can confirm diagnosis of hydatic cyst. The treatment of Fallopian tube hydatic cyst is surgival and often radical (salpingectomy).

A new approach to the surgical treatment of parasitic cysts of the liver: Hepatectomy using the liver hanging maneuver

AIM: To review 11 patients with parasitic cysts of the liver, who were treated by hepatic lobectomy using the liver hanging maneuver (LHM).

METHODS: Between January 2003 and June 2006, we retrospectively analyzed patients who underwent surgical treatment due to parasitic cysts of the liver, at the Ege University School of Medicine, Department of General Surgery. Of these, the patients who underwent hepatic lobectomy using the LHM were reviewed and evaluated for surgical treatment outcome.

RESULTS: Over a three-year period, there were 102 patients who underwent surgical treatment for parasitic cysts of the liver. Of these, 11 (10%) patients with parasitic cysts of the liver underwent hepatic lobectomy using the LHM. Presenting symptoms were abdominal pain, dyspepsia, and cholangitis. Cyst locations were as follows: right lobe filled with cyst, 7 (63%); segmental location, 2 (18%); and multiple locations, 2 patients (18%). All patients underwent hepatic lobectomy with an anterior approach using the LHM. The intraoperative blood transfusion requirement was one unit for 3 patients and two units for one patient. Postoperative complications included pulmonary atelectasy (2, 18%) and pleural effusion (2, 18%). No significant morbidity or mortality was observed.

CONCLUSION: We concluded that hepatic lobectomy using the LHM should be considered, not only for hepatic tumors or donor hepatectomy, but also to treat parasitic cysts of the liver.