Scientia Parasitologica, 2007, 2-3, 48-51

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Isolated Pelvic Hydatic Cyst Fistulised

In The Urinary Bladder

I. COMANa, B. FECICHEa, I.D. SÂRBa, T. CRISTEAa, C-tin BODOLEAa, T. GUTTMANb, Carmen COSTACHEc, Cătălina BUNGĂRDEANd, Renata VASIUd

a Urological Departament Clinical Municipal Hospital, Cluj-Napoca, Romania b Imagistic Departament Oncological Institute Cluj-Napoca c Microbiology Departament Medical University „Iuliu Hatieganu” Cluj-Napoca d Pathology Departament Clinical Municipal Hospital, Cluj-Napoca, Romania *Corresponding author – Departament of Urology, Clinical Municipal Hospital Cluj-Napoca, Tabacarilor Street No 11, Cluj-Napoca, Romania. E-mail address: bfeciche@yahoo.com (Dr. Bogdan Feciche) ABSTRACT. We report on the case of a 23-year-old male with non-systematized pelvic pain and dysuria caused by a large hydatic cyst with retrovesical position and without any other site of the disease in the body. Clinical, imagistic, microbiological and therapeutical aspects of this relatively rare case are presented. Keywords: bladder, fistula, hydatic There is no conflict of interest for any of the authors of this article. Word count: 397 Case Report

A 23 year-old male, with no history of urinary tract infections, was referred to the urologist after a 2 months history of dysuria and non-systematized pelvic pain. The physical examination revealed no abnormal relations.

The ultrasound showed the presence of a multicystic pelvic mass, involving the posterior wall of the urinary bladder. No other pathological elements were revealed in the abdomen (Figure 1).

The diagnostic procedures performed were: blood tests, descendent pyelography and computer tomography. The pyelography showed a dislocation of the bladder, compressed by a superior-posterior localized tumor (Figure 2). The computer tomography indicated the presence of a retrovesical tumor with a multicystic structure and involvement of the bladder (Figure 3).

The suspicion of a hydatic cyst which fistulises in the bladder was followed by the

immunological test ELISA, which was positive, and a complete imagistic evaluation of the liver and lungs which revealed normal findings.

The preoperative diagnosis was hydatic cyst with pelvic unique localization wich is fistulised to the urinary bladder.

The therapeutical indication is exploratory laparotomy with excision of the hydatic cyst without spillage of cystic fluid. The intervention was performed under general anesthesia with specifical preparation for hydatic disease (Albendazole 400 mg twice daily 10 days bedore surgery). An ideal tumorectomy was performed for this purpose, with a partial posterior bladder wall resection (Fig 4). The excision was complete without lesions of the cyst or macroscopic relicvat. The digestive structures didn’t presented any modifications. The postoperative evolution was optimal the peritoneal drain being remouved in the 3rd day and the vesical catheter in the 7th day.

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The macroscopic evaluation after the tumor removal revealed a typical aspect for hydatic membrane with so called „daughter vesicles” (Figure 5 and Figure 6)

The microscopic evaluation proved the hydatic origin of the tumor; the Echinococcus granulosus being identified.

The postoperative evolution was optimal and the evaluation at 12 months revealed no sign of disease recrudescence. An epidemiological anquete was initiated.

We presented this case for the rare character of the primary site of hydatic disease in the genito-urinary tract especially without the involvement kidney.

Figure 1 Ultrasound examination presenting a retrovesical multicystic structure

with involvement of the bladder (transversal plane)

Figure 2 Descendent pyelography revealed the extrinsec compression of the bladder

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Figure 3 Computer tomography presented a retovesical multicystic mass

with the involvement of the bladder

Figure 4 Intraoperative aspect. The bladder is retracted anterior

to improve the dissection of the cyst

Figure 5 The cystic mass is opened after the remouval and is revealed the hydatic membrane with its content of “daughters vesicles”

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Figure 6

„Daughters vesicles” from the interior aspect of the cyst REZUMAT

Chist hidatic pelvin izolat fistulizat în vezica urinar ă

Prezentăm cazul unui bărbat în vârstă de 23 de ani care s-a adresat serviciului nostrum

cu dureri pelvine nesistematizate şi disurie cauzate de un chist hidatic voluminous cu localizare retrovezicală şi fără alte semne de boală în organism.

Aspecte clinice, diagnosice, patologice şi terapeutice sunt prezentate.