Hydatid cyst of the parietal peritoneum

Abstract

Introduction: Hydatid disease is a type of zoonosis that is caused by Echinococcus granulosus which is transmitted by the fecal-oral route. The disease is endemic in certain areas like the Mediterranean region, South America, and some parts of the central Europe. It commonly affects the liver, the lungs and the brain. But all organs could be affected. Multiple organs could be affected simultaneously. The presentation depends on the site and the size of the cyst. It may cause pain or pressure effect. Emergency presentations occurs when the cyst rupture. The disease is usually diagnosed by CT scan or MRI.Medical treatment may be effective in the uni-vesicular cyst or used after surgery to decrease the recurrence rate. Surgery is still the main treatment option. Case presentation: An 11-year-old boy presented with left lower quadrant abdominal pain for 4 months. The pain was dragging like pain that was aggravated by movement and standing position and relieved with rest and analgesics. There was no any associated symptom. Examination of the abdomen showed a palpable oval shaped mass in the left iliac fossa. The mass was about 10 cm by 5 cm and disappeared with abdominal wall contraction. The complete blood count was normal and the ultrasound examination showed a cystic lesion that arises from the abdominal wall, the position of the mass was constant by changing the position of the patient. During laparotomy there was a cystic lesion that arises from the parietal layer of the of the peritoneum behind the posterior rectus sheath on the left side. Complete excision of the cyst done. The cyst was a solitary hydatid cyst that affects this rare location. The patients discharged home after 4 days with good medical condition. Conclusion: The presence of any cystic lesion in any organ in a patient from an endemic area for hydatid disease should raise the suspicion to this possibility. Treatment options should be chosen by a multidisciplinary team; certain group of patients may benefit from medical treatment. Surgery is still the main treatment modality. Keywords: Hydatid disease, Echinococcosis, Echinococcus granulosus, Parietal peritoneum