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International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198
Int J Case Rep Images 2019;10:101042Z01AV2019. www.ijcasereportsandimages.com
Amarjothi et al. 1
CLINICAL IMAGE PEER REVIEWED | OPEN ACCESS
An interesting case of secondary hydatidosis
Amarjothi JMV, Villalan Ramasamy, Jeyasudhahar J, Naganath Babu OL
CASE REPORT
A 39-year-old woman presented with a history of abdominal distention over a year. She was not in possession of pets. An ultrasound was done initially which revealed pelvic cysts. Then computed tomography (CT) scan was done which revealed multiple septate cysts in the liver and between bowel loops in the peritoneum with some even in the Pouch of Douglas in the pelvis (Figures 1 and 2). Laboratory investigations including CA 125 were normal except for positive echinococcosis serology test (Counter immunoelectrophoresis [CIE] and latex agglutinin test [LAT]).
As the patient had disseminated disease and was without complications. She was started on continuous course of albendazole (10 mg/kg/day) for 12 weeks and was compliant with medication.
DISCUSSION
Peritoneal hydatidosis by itself is quite rare with an incidence of about 10–16% [1]. Primary peritoneal hydatidosis characterized by peritoneal hydatid lesions without liver and other organ involvement is very rare at 2% of all abdominal hydatids [2]. The mechanism of primary peritoneal infection though unknown is thought to be through the hematogenous and lymphatic route [3]. In contrast to mucosal surfaces, serosal surfaces like pleura or peritoneum constitutes a friendly microenvironment for the development of echinococcal cysts [4].
Amarjothi JMV1, Villalan Ramasamy1, Jeyasudhahar J1, Naganath Babu OL2
Affiliation: 1Registrar, Department of SGE, MMC, Chennai, Ta-mil Nadu, India; 2Professor, Department of SGE, MMC, Chen-nai, Tamil Nadu, India.Corresponding Author: Amarjothi JMV, 500, Tower Block II, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India; Email: [email protected]
Received: 08 August 2018Accepted: 11 March 2019Published: 19 August 2019
Secondary peritoneal echinococcosis is more common than primary peritoneal disease. It is due to microrupture and dissemination from the hepatic lesions. This may occur during surgery (5–10% cases) or trauma [5]. Rarely, the rupture may even be spontaneous.
Diagnosis of peritoneal hydatid is most commonly by CT which showed well-defined lesions with or without
Figure 1: Sagittal section showing multiple septate cysts throughout the abdominal cavity.
International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198
Int J Case Rep Images 2019;10:101042Z01AV2019. www.ijcasereportsandimages.com
Amarjothi et al. 2
internal septations. Serological tests show marked variation in sensitivity and specificity. Antihelminthics are the main mode of treatment in disseminated disease [6].
Combination therapy of praziquantel and albendazole is more effective [7]. However, Albendazole monotherapy is highly effective protoscolicidal agent both in vitro and in vivo with a better safety profile [8]. Long-term chemotherapy will significantly increase survival even for such inoperable cases. On chemotherapy, cure can be expected to occur in 30% of patients with improvement in 30–50% on follow-up after 12 months [6].
The prognosis of peritoneal hydatidosis depends on location of the cyst in peritoneal cavity and condition of the patient. The increase in morbidity is due to deep infected collections and recurrence (10–18%) by subserous grafts [9].
CONCLUSION
The differential of hydatid cyst must be borne in the diagnosis of pelvic cystic lesions even in non-endemic areas, especially in female where these lesions sonologically may resemble ovarian cysts. Long-term antihelminthic treatment with albendazole is ideal for disseminated disease and may obviate the need for surgery.
Keywords: Hydatid cyst, Secondary hydatidosis
How to cite this article
Amarjothi JMV, Ramasamy V, Jeyasudhahar J, Naganath Babu OL. An interesting case of secondary hydatidosis. Int J Case Rep Images 2019;10:101042Z01AV2019.
Article ID: 101042Z01AV2019
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doi: 10.5348/101042Z01AV2019CI
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3. Majbar MA, Souadka A, Sabbah F, Raiss M, Hrora A, Ahallat M. Peritoneal echinococcosis: Anatomoclinical features and surgical treatment. World J Surg 2012;36(5):1030–5.
4. El Mufti M. The simple hepatic hydatid cyst. In: El Mufti M, editor. Surgical Management of Hydatid Disease. London: Butterworth; 1989. p. 31–54.
5. Wani RA, Malik AA, Chowdri NA, Wani KA, Naqash SH. Primary extrahepatic abdominal hydatidosis. Int J Surg 2005;3(2):125–7.
6. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO informal working group on echinococcosis. [Article in French]. Bull World Health Organ 1996;74(3):231–42.
7. Mohamed AE, Yasawy MI, Al Karawi MA. Combined albendazole and praziquantel versus albendazole alone in the treatment of hydatid disease. Hepatogastroenterology 1998;45(23):1690–4.
8. Alvela-Suárez L, Velasco-Tirado V, Belhassen-Garcia M, et al. Safety of the combined use of praziquantel and albendazole in the treatment of human hydatid disease. Am J Trop Med Hyg 2014;90(5):819–22.
9. Benamr S, Mohammadine E, Essadel A, et al. L’hydatidose peritonéale secondaire: Mise au point à propos d’une série de 50 cas. Med Maghreb 2000;15(82):15–20.
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Author ContributionsAmarjothi JMV – Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolvedVillalan Ramasamy – Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolvedJeyasudhahar J – Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation
Figure 2: Multiple septate cysts in pelvis.
International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198
Int J Case Rep Images 2019;10:101042Z01AV2019. www.ijcasereportsandimages.com
Amarjothi et al. 3
of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolvedNaganath Babu OL – Conception of the work, Design of the work, Acquisition of data, Analysis of data, Interpretation of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone.
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Conflict of InterestAuthors declare no conflict of interest.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Copyright© 2019 Amarjothi JMV et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
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