Management of a primary retroperitoneal hydatid cyst rupture
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An 87-year-old female living in a rural area, with no past medical, surgical, or drug history, was referred by a family physician to our department, for an isolated right flank mass evolving progressively for 3 months. On physical examination, the patient had a superficial and well-defined 15 cm-cystic-mass of the right flank. The physical examination found a painlessly palpable, firm, and fluctuant mass, measuring 15 cm. The remainder of the physical examination was normal. The patient’s Blood Tests revealed a biological inflammatory syndrome with hyperleukocytosis and a high C-reactive protein. In addition, eosinophilia of 15% was noticed in the complete blood cell count. Her Hydatid serology test result was positive.

Abdominal ultrasound showed a cystic mass, with a diameter of 15 cm, protruding in the subcutaneous area. These results were highly suggestive of hydatid disease.

An abdominal computed tomography was performed to determine the mass’ location and its intra or extraperitoneal extension. The CT revealed a 20?×?15 cm cystic mass with an enhanced thick wall, containing several septa within, extending to the subcutaneous tissues of the right side of the abdominal wall. The mass was independent of any intra-peritoneal organ. However, the voluminous cyst caused a significant mass effect on adjacent organs especially the right kidney. The diagnosis of a retroperitoneal hydatid cyst ruptured into the abdominal wall was established. The patient received preoperative antiparasitic chemotherapy based on

Albendazole 400 mg twice daily for one month. Then, she underwent surgical treatment three days after admission. Surgical drainage by an elective right flank incision was performed by an associate professor in general surgery, under general anesthesia with the patient in the left lateral decubitus position. The punction of the cyst resulted in the aspiration of approximately 1500 mL of purulent material including daughter vesicles. The cyst was then completely emptied of its content. Drainage of the residual cavity was performed. The postoperative course was uneventful. The patient was discharged 8 days after hospitalization and was followed at the outpatient clinic. She received an adjuvant Albendazole treatment for 6 months. The clinical and radiological follow-up for 12 months showed no evidence of recurrence and the patient was satisfied with the result.