Subileus Caused By A Retroperitoneally Located Hydatid Cyst Disease: Case Report

摘要

Hydatid disease (Hydatidosis) is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most commonly involved organ, this disease can be seen anywhere in the body. Hydatid disease of the retroperitoneum is a very rare condition. Hydatid cysts with unusual localizations may cause serious problems. Early diagnosis is important, because prompt intervention enables efficient management and treatment of the disease and results in reduced morbidity and mortality. Initially, cysts are small and patients are asymptomatic.We report a case of a subileus in a 63-year-old male with the diagnosis of hydatid cyst of retroperitoneum, which was treated surgically. Introduction Hydatid disease is a parasitic infection with worldwide distribution, especially in sheep and cattle-rearing regions of Australia, South America, the Middle East, South Africa, Eastern Europe, and the Mediterranean region (1). Hydatid disease (HD) is a parasitic infection caused by Echinococcus granulosus and less frequently by Echinococcus multilocularis. HD mostly occurs in the liver (59-75%), followed in frequency by lung (8.5-43%), and only 10-15% occur in other parts of the body (2). Although effective preventive and therapeutic measures have been developed for most parasitic helminths, cystic echinococcosis (CE) infection is still very common in the developing world today. CE, a widely chronic endemic helminthic disease caused by infection with metacestodes (larval stage) of the tapeworm Echinococcus granulosus, is one of the most widespread helminth zoonotic diseases in humans (3-4). Despite the advances in modern imaging and therapeutic strategies, problems associated with the diagnosis and treatments of human CE are still challenging and often difficult to resolve. Early diagnosis is important, because prompt intervention enables efficient management and treatment of the disease and results in reduced morbidity and mortality. Initially, cysts are small and patients are asymptomatic (5)Localization of hydatid disease in the retroperitoneal space causing subileus is extremely rare. Case Report A 63-year-old man was admitted to our hospital with a swelling in the suprapubic region for 15 years. Physical examination revealed a palpable suprapubic tenderness. Laboratory examinations were normal. Ensuring workup included a positive serology for Echinococcus. Chest x-ray was within normal limits. Upright abdominal radiographs showed abnormal gaseous distension/dilatation of small bowel loops, with fluid levels (Figure 1). Ultrasound examination revealed a round thick-walled cyst close to the sigmoid colon. On the abdominal computerized tomography scan, a multilocular thick-walled round septated cyst of 10x8x7cm was seen (Figure 2). Total cystectomy with capitonnage tube drainage and irrigation with betadine was the operation of choice for the hydatid cyst. Histopathological examination confirmed the diagnosis of a hydatid cyst (Figure 3). The patient was discharged on the fifth postoperative day.