Primary pelvic hydatid cyst in an infertile female
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A 20-year-old infertile female with the chief complaint of abdominal pain for several days. Clinical examination revealed low blood pressure (95/60 mm/Hg), pale mucosa, and general tenderness in abdomen with focus in lower quadrants of abdomen. Patient declared that had no past medical history but a 40 day old abortion. The patient declared some cases of infection with Mycobacterium tuberculosis (TB) in first and second degree relatives.

Ultrasonography suggested a large multilocular cyst (74 × 90 mm) attached to the right ovary. A large amount of free fluid around the cyst suggesting the cyst rupture observed. In addition, MRI of the abdomen and pelvis showed a normal liver, bile duct, pancreas, kidney, bladder, and uterus and in contrast-enhanced sequences a large multilocular cystic structure with enhancing septa about 70 × 84 × 124 mm was noted. Few amount (3 mL) of fluid was aspirated from pelvis and sent for pathologic study. The results of pathologic investigation demonstrated that the fluid contained mesothelial and inflammatory cells.

Preoperative therapy with albendazole started for patients with dose (10-15 mg/kg/d) for 28 days. In laparotomy, a large tense hydatid cyst was noted in the pelvic cavity and multiple small daughter cysts adhered to pelvis organs were observed. Also, bloody fluid in abdomen and pelvis which were resulted from cyst rupture was noted. In the initial view, it was similar to abdominal tuberculosis which was in accordance with tuberculosis history in patient's family. Cyst was completely excised after mobilization without rupture and by packing the surrounding area with 1% cetrimide soaked sponges then, abdominal and pelvis cavity washed to reveal adhesions. All daughter cysts and laminated membrane removed completely and a drain was placed in the pelvis and abdomen sutured in layers. The final diagnosis was confirmed by pathological examination. Due to the familiar history of Mycobacterium tuberculosis, abdominal tuberculosis justified, nevertheless, pathology approved hydatid cyst in the abdominal and pelvis cavity and follicular cyst in the ovary. The patient was put on albendazole therapy for 3 cycles and the dose of the albendazole was adjusted according to the bodyweight of the patient.