Surgical exploration done by lower abdominal pfannenstiel incision,. The mass was in midline, and was located in posterior to the bladder, pushing the posterior ...
HugeI sol at edRet r ov esi cal Hy dat i dCy stAf f ect i ngal i t t l egi r l . Acaser epor t . Dr .AzzawiM.Hadi ,Assi st antpr of .Depar t mentofsur ger y ,Ti kr i tmedi cal col l ege Abst r act A 8y earol d gi r lpr esent ed wi t h pai n abdomen & f r equency . Ul t r asound&CTscanofabdomenshowedhy dat i dcy stRet r ov esi calar ea. Sur ger ywasper f or medandpat hol ogyoft heexci sedmassconf i r medt he di agnosi s.Ther ar i t yoft he caseofpr i mar yr et r ov esi calhy dat i dcy sti n suchear l yageandsuchahugesi zewast heur gi ngcauset opr esenti t .
KeyWor ds:Hy dat i dcy st , Ret r ov esi cal, Echi nococcusgr anul osus. CaseDescr i pt i on A8y earol dgi r lpr esent edwi t h4mont hsabdomi nalpai nwhi chwas mi l d butcont i nues,par t i al l yr espondi ng t o anal gesi cs,she al so had f r equencyandnuct ur i a.notassoci at edwi t hdy sur i a,norhemat ur i a.she hadnor emar kabl esy st emi cmani f est at i ons,norasi gni f i cantev i dencei n t hepastmedi cal ,and sur gi calhi st or y .shecompl et ed herv acci nat i on schedul ei nt i me.shebor nandl i v esi nr ur al ar ea. Onexami nat i onshewasv er ywel l ,andno f i ndi ngcanbedet ect ed ot hert hanmi l dl owerabdomi nalt ender ness,wi t hpal pabl esof tmass. ur i nal y si s was nor mal ,as wel lherbl ood and bi ochemi cali ndexes. Abdomi nalul t r asoundr equest ed,t her epor tsai dt hatshehadnor mall i v er abdomi nalor gans,wi t hacy st i cmasspost er i ort ot hebl adderof7x6cm, whi chcont ai nechof r eef l ui d,gi v esadef er ent i aldi agnosi sofmesent er i c cy st ,bi gov ar i ancy st ,congeni t aldi v er t i cul um.Axi alCTscanconf i r med
t hesef i ndi ngsasshowni nf i g( 1) . Sur gi calexpl or at i ondonebyl owerabdomi nalpf annenst i eli nci si on, Themasswasi nmi dl i ne,andwasl ocat edi npost er i ort ot hebl adder , pushi ngt hepost er i orbl adderwal lant er i or l y .Al lot herabdomi nalor gans wer enor malaswel lt hechestv i ewsoft heCTwer enor mal.Sur ger ywas per f or medt oexci set hemass.t hecy stcont ent saspi r at ed, whi chwascl ear f l ui d.andt her ewasanendocy stofhy dat i dcy stt hathav ebeenpr ov edby t hemi cr oscopi cexami nat i onwhi chr ev eal edal ami nat edmembr ane, f i g( 2) . Postoper at i v el yshehadasmoot hr ecov er y , andsenthomeonal bendazol e t ab200mg dai l yi nt wodi v i deddosesf or3mont hs.Thegi r lf ol l owedf or oney earbyabdomi nal ul t r asound, t hatshowsnoev i denceofr ecur r ence. Di scussi on. Echi nococcusgr anul osust hepar asi t et hatcauses hy dat i d di seasei s endemi ci nmanyar eas oft hewor l d.Hy dat i dcy st scandev el opi nal most ( 1) anypar toft he body .I n mostcases,t he f i r stand mosti mpor t ant
l ocat i onsf ort hi spar asi t ear et hel i v erandt hel ungs.Hy dat i ddi seaseoft he ur i nar yt r acti suncommon, account i ngf oronl y2–3%ofal lhy dat i dcases(2). I fhy dat i d cy st sl ocat ed atsome t he unusualsi t es,i t maycause a di agnost i cuncer t ai nt y.Per i t onealcav i t yhy dat i dcy st sorpel v i chy dat i d cy st s ar eusual l yr esul tf r om r upt ur eofapr i mar yl i v erf ocust hatoccur ( 1) spont aneousl y ordur i ng sur gi calmanagement .Al t hough t he most
common si t e of echi nococcali nv ol v ement i st he l i v er ,y et cy st i c echi nococcusi nf est at i oncanoccuri nanypar toft hebodyandshoul dbe consi der edi nt hedi f f er ent i aldi agnosi sofanycy st i cmasses(3).I sol at ed r et r ov esi calhy dat i dcy st ,howev er, i sv er yr ar esi t ewi t haf ew cases ( 4, 5, 6) r epor t edi nl i t er at ur eonl y .Unusual l yr et r ov esi calhy dat i dcy stcanbea 8) causef orr et ent i onofur i ne(7, .I tcanpr esent edasanext r aper i t onealcy st ,
( 9)
aswel li nt her et r ov esi calar ea .Thedi agnosi si sbased oncl i ni cal f i ndi ngs,i magi ngt echni quesandser ol ogy .Ul t r asoundi susef ulasaf i r st l i ne i nv est i gat i on i n ev al uat i on ofcy st si nt he abdomen.Comput ed t omogr aphyandMRIar ei ndi cat edi ndi ssemi nat eddi sease, l esi onsl ocat ed out of t he abdomen, subdi aphr agmat i c si t es, and pr eoper at i v e 11) ev al uat i on(10, .Abdomi nal ul t r asound&nat i v eCTscanr egar dedhel pf ul i n
di agnosi sofabdomi nalhy dat i ddi seaseandpr ov et hesuspi ci onoft he cl i ni calpr esent at i on.Al t hought her ewasauni l ocul arcy sti nourcase,t he mul t i l ocul arappear anceoft hecy stsuppor t ed byt he densi t yoft hecy st 13) cont ent si ndi cat edt hatt hecy stwasal i v e&v i abl e(12, .Sagi t t alf astspi n-
echo T2wei ght ed MR i mage cl ear l yi dent i f i es smal lcy st i cl esi ons r epr esent i ng daught ercy st s(14).TheDév è' scl assi calt heor yst at est hat f i ssur i ngorr upt ur eofapr i mar yhepat i c,spl eni cormesent er i ccy stmay seedi t scont ent st ot heabdomi nalcav i t y ,l eadi ngt oanew l esi ons,whi l e t hepr i mar ycy stmayhealanddi sappear ,l eav i ngbehi ndascart hatmay 15, 16) notdet ect edbyanydi agnost i ct ool s(11, .Haemat ogenousorl y mphat i c
di ssemi nat i oni sanot hert heor yt r i edt oexpl ai nt heabsenceoft hepr i mar y 15, 16) v i scer all esi on,andt heabsentev i denceofper i t onealseedi ng(11, . Ot her
hy pot hesi ssai dt hatt hel ar v amayr emai nedi nt her ect alampul l aand mi gr at ed t hr ough t he haemor r hoi dalv essel st or each a per i r ect alor r et r ov esi cal l ocat i on(17). Sur gi calt r eat mentofSy mpt omat i cl ar gehy dat i d cy st sbycy st oper i cy st ect omy st i l lt he gol d st andar d pr ocedur e(18).Pr eoper at i v e and post oper at i v e use ofal bendazol e hav e been f ound t o decr eases t he v i abi l i t yofcy st satt he t i me ofsur ger yand si gni f i cant l yr educest he chancesofcy str ecur r ence.Thus,al bendazol ei sr egar dedasanef f ect i v e ( 19) adj uv antt her apyi nt hemanagementofhepat i chy dat i dcy st .Thecy st ' s ( 20) gr owt hr at ei sofabout10mm pery ear ,buti ti ssur pr i si ngt hatt hecy st
i nt hi scaser eachessuchasi zeatt hi sage. Concl usi on Hy dat i dcy stshoul dbe r egar dedasoneoft hedi f f er ent i aldi agnoses i npat i ent swi t hani sol at edr et r ov esi calcy st sdi scov er eddur i ngr out i ne assessment f or ot her condi t i ons,such as pat i ent s pr esent ed wi t h nonspeci f i c sy mpt oms of l ower ur i nar yt r act ,because pr ophy l act i c measur esneed t o beconsi der ed i nt heoper at i on t ot ake pr ev ent i oni nconsi der at i on.
spi l l age
Ref er ences 1-Shai l eshChandr aSahayetal,I sol at edr et r ov esi calhy dat i dcy st . BJUI w2010019. 2-GogusO,BedukY,TopukcuZ.Renalhy dat i ddi sease.Br i tJUr ol 1991; 68: 466–9. 3-Engi nG, AcunarB, Roz anesI , AcunarG.Hy dat i ddi seasewi t hunusual l ocal i zat i on.EurRadi ol 2000; 10( 12) : 190412. 4-Raj eshShar ma,Rupal iBar got r a,Tar i qAzad,MandeepSi nghHy dat i d Cy sti nRect ov esi cal Pouch, JKSci ence2004;6(2) : 1012. 5-Khouaj a MK,Ben Sor ba N,Haddad N,Mosbah AT.Ret r ov esi cal hy dat i dcy st :di agnosi sandt r eat menti n8cases.Pr ogUr ol2004; 14: 48992. 6-Hor chaniA,Noui r aY,Cht our ouM,Kacem M,Saf t aZB.Ret r ov esi cal Hy dat i dDi sease:ACl i ni calSt udyof27Cases.EurUr ol2001; 40:65560. 7-Dogr aPN,Tanej aR.Ret r ov esi calhy dat i dcy st :anunusualcausef or r et ent i onofur i ne.I ndJUr ol , 1995; 11( 2) : 8283. 8-Emi r aL, Kar abul ut aA, Bal ci aU, Ger mi y anoğl uaC, Er ol aD.Anunusual causeofur i nar yr et ent i on:apr i mar yr et r ov esi calechi nococcalcy st . Ur ol ogy2000; 56: 856. 9-Angul o JC,Escr i bano J,Di ego A,Sanchez Chapado M.I sol at ed r et r ov esi calandext r ar enalr et r oper i t onealhy dat i dosi s:cl i ni calst udy of10casesandl i t er at ur er ev i ew. JUr ol 1998; 159: 7682. 10-
WHO I nf or malWor ki ngGr oup.I nt er nat i onalcl assi f i cat i onof
ul t r asoundi magesi ncy st i cechi nococcosi sf orappl i cat i oni ncl i ni cal andf i el depi demi ol ogi cal set t i ngs.Act aTr op.2003;85: 253261. 11-
Per i gel aHC,ReddyMK,Pr asadBV,Nar ahar iJ.Gi antpel v i c
hy dat i dcy st .JDrNTRUni vHeal t hSci .2013; 2: 218221.
12-
Gossi or KJ, Kont oy i anni o
DS, Dascal ogi annaki M,
Gour t soy i anni s NC.Uncommon l ocat i ons ofhy dat i d di sease:CT appear ances.EurRadi ol 1997; 7( 8) : 130308. 13-Kot oul asG, Goul i amosA, Kal ov i dour esA, Vl ahosL, Papav asi l i ouC. Comput edTomogr aphi cl ocal i zat i onofPel v i chy dat i ddi sease.Eur Radi ol 1990; 11( 1) : 3841. 14-A.M.Hal ef ogl u&A.YasarHugeRet r ov esi calHy dat i dCy stwi t h Pel v i cLocal i zat i onast hePr i mar ySi t e:ACaseRepor t .Act aRadi ol 2007( 8) : 91820. 15-Angul o JC,Escr i bano J,Di ego A,Sanchez Chapado M ( 1998) I sol at ed r et r ov esi caland ext r ar enalr et r oper i t onealhy dat i dosi s: cl i ni cal st udyof10casesandl i t er at ur er ev i ew.JUr ol 159: 7682. 16-Sar karS,Sany alP,DasM,KumarS,Panj aS( 2016)Acut eur i nar y r et ent i onduet opr i mar ypel v i chy dat i dcy st :ar ar ecaser epor tand l i t er at ur er ev i ew.JCl i nDi agnRes10: PD06PD08. 17-Al der sN, Woj ci echowskiM.AnI sol at edRet r ov esi calHy dat i dCy st i naChi l d: ARar eCasePr esent at i on.Ar chPar asi t ol .2017; 1: 103. 18-Bal i kI AA,Cel ebiF,Basgl uM etal .I nt r aabdomi nalext r ahepat i c echi nococcus.Sur gToday2001; 31( 10) : 81824. 19-
ShamsUl Bar i ,Saj adHussai nAr i f ,[ . . . ] ,andZahoorA.Nai koo.
Rol eofAl bendazol ei nt heManagementofHy dat i dCy stLi v er .Saudi JGast r oent er ol .2011; 17( 5) : 343–347. 20-
Emi rL,Ger mi y anogl u C,Lokumcu A,Er olD Ret r ov esi cal
echi nococcalcy stcausi ngr enalf ai l ur eannoct ur nalenur esi si na chi l d.Jour nal ofPedi at r i cSur ger y . 2001;36: 14.
Fi g1: CTscanf i ndi ngs, 7x6cm r et r ov esi cal cy st .
Fi g2: par toft heper i cy standendocy st
