Disseminated Hydatidosis: A Case Report

Abstract

Introduction: Disseminated abdominal hydatidosis is a rare presentation of hydatid disease. It represents 5–16% of all localizations. Peritoneal implantation of daughter cysts usually occurs as a consequence of traumatic or surgical liver hydatid cyst rupture. We report a case of disseminated hydatidosis in the department of visceral surgery of Mongi Slim hospital in Marsa.

Observation: A 60-year-old man from Kasserine (hyper-endemic area of hydatidosis), who had a hemostasis splenectomy in 1997, with a 9-month history of abdominal distension and dyspnoea on exertion.

On examination he had sub-jaundice with an asymmetrical distended abdomen. Thoraco-abdomino-pelvic CT scan revealed multiple echinococcal cysts in the liver, peritoneal cavity, retroperitoneum and right lung, at various stages of development. He was operated, with a selective left intubation.

The surgical procedure consisted on a resection of protruding domes, enucleation of transverse mesocolon cysts, retrograde cholecystectomy, trans cystic drain and residual cavity drainage.

It is recommended to perform excision (cystectomy, peri-cystectomy) of cysts that are easily and safely accessibles, and partial cystectomy (resection of the protruding dome) with evacuation of the parasite for deep cysts in close contact with the vessels, mesos and viscera, when local and general conditions do not allow it.

The prognosis of the disease depends on the extent of peritoneal dissemination, the existence of visceral localizations and their severity, the general condition of the patient, the completeness of the cure and the experience of the surgeon.

Conclusion: Dissiminated hydatidosis is a rare but serious presentation of hydatid disease. Surgery is the mainstay of treatment of peritoneal hydatidosis, based on radical or conservative methods.