A giant primary peritoneal echinococcosis: A rare form of a common disease.

A 33-year-old male presented with progressive abdominal distension and discomfort for 3 years. Abdominal examination revealed a bloated abdomen. There was presence of fluid thrill but no shifting dullness or organomegaly could be elicited. Hydatid serology (ELISA) was positive: 35 kU/L. The contrast-enhanced CT of the abdomen and pelvis (Fig. 1) showed that the entire peritoneal cavity was distended and occupied by multiloculated non calcified content of mixed attenuations. A laparotomy was rapidly scheduled in order to avoid rupture of the cyst, which could be fatal due to anaphylactic shock. On exploration, it was found that there was a cyst occupying the entire peritoneal cavity. Liver, pancreas, spleen and other organs were normal (Fig. 2). A subtotal excision of the cyst was performed (Fig. 3). Postoperative period was uneventful. The patient was prescribed albendazole tablets, 400 mg, twice a day for 3 months. Histopathological examination of the specimen was consistent with a hydatid cyst wall.

Fig. 1

Abdominal CT scan showing that the entire peritoneal cavity was distended and occupied by multiloculated non calcified content of mixed attenuations.

Fig. 2

Operative view of the cyst.

Fig. 3

Operative view of the open cyst.

Hydatid disease is a parasitic infestation that is caused by Echinococcus granulosus, occurring in countries of Mediterranean. Common affected organs are liver (75%) and lung (15%) [1], [2]. Peritoneal echinococcosis (13%) is usually secondary following spontaneous rupture or accidental spillage during surgery [3]. Primary peritoneal echinococcosis is very rare [4]. The dissemination is made via lymphatic way or systemic circulation. These locations may cause difficulties in making the diagnosis and this can lead to many potentially serious complications. There are no specific clinical signs, a pelvic hydatid cyst present with a nonspecific mass with signs of urinary and rectal compression. The diagnosis is based on radiologic findings and serologic tests [5]. Surgery is the optimal treatment; the type of surgery intervention used depends on each patient.Total surgical excision is the treatment of choice but it is not always feasible [4]. It is imperative to protect the abdominal wall and viscera to avoid the risk of spillage [3]. Partial excision is performed when we note that the removal of the cyst is considered to do more harm than good There is no consensus on the exact indications for anthelmintic therapy [3]. However, combination of preoperative albendazole therapy, surgery then postoperative albendazole therapy is a useful regime to prevent recurrences [2].

CRediT authorship contribution statement

Ghassen Hamdi Kbir, Sohaib Messaoudi and Eya Ben Nejma: Clinical management of the patient, writing and editing the manuscript. Mohamed Maatouk and Mounir Ben Moussa: Writing, editing the manuscript.

Ethical approval

We have reported a singel case with no requirement for ethical approval.

Consent

Written informed consent was obtained from the patient for the publication of this case report and its accompanying images.

Conflict of interest statement

We declare no relationships that may pose a conflict of interest.