Authors : Kalpana Mahadik1 Kunjan Ladikar2
1. Professor & HOD, Dept. of Obstetrics and Gynaecology
2. Postgraduate student III yr , Dept. of Obstetrics and Gynaecology
Introduction
Hydatid disease is a zoonotic parasitic disease most frequently caused by Echinococcus granulosus.1 Primary hydatid cyst in the pelvis is an extremely rare site of the disease and occurs in approximately 0.7% of the patients.2
Clinical picture
A 40 year old female (para 4 living 4), presented with pain in the epigastric region since one and a half year and a lump in abdomen since 6 months. On per abdomen examination a cystic , mobile , non-tender mass with well defined margins, smooth surface of about 14 -16 week size gravid uterus was palpable. Ultrasound examination showed a large, well defined, cystic mass of pelvic origin suggestive of ovarian cyst. Patient underwent exploratory laparotomy followed by abdominal hysterectomy with left salpingo-ophrectomy with cystectomy. Intraoperatively a large cystic lesion was present on anterior uterine wall and similar cystic lesions were present in the left broad ligament as well as pouch of douglas. On incising multiple daughter cysts were found thereby a diagnosis of multiple hydatid cysts was made.
Discussion
Echinococcus granulosa can reach any organ or tissue of the body where it develops into a hydatid cyst.1 Echinococcus cyst is found more frequently in the liver (60%), followed by the lungs (15%), but they can occur anywhere in the body.3 The pelvic organ in women is rarely the primary site of cyst formation. The hydatid embryo gains access to the pelvis by hematogenous or lymphatic route. The cyst may remain asymptomatic for long period of time and may be discovered incidentally or cause irritation or compression symptoms.4 Ultrasound is the preferred first-line imaging but CECT gives more precise information regarding the morphology.5 Surgery is the most effective treatment.6 En bloc resection without inducing rupture and spreading the daughter cyst is recommended treatment and is accepted to be curative.7
Conclusion
Pelvic hydatid cyst in women may be mistaken for the cysts of the genital organs, because they arise in the pelvic cellular tissues. Mistaken diagnosis of ovarian cyst needs an attention and we should keep this diagnosis in mind though it is rare.
References :
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7. Fazl Q. Parray, Shadab Nabi Wani, Sajid Bazaz, Shakeel-ur Rehman Khan, and Nighat Shaffi Malik. Primary Pelvic Hydatid Cyst: A Case Report. Case Reports in Surgery, vol. 2011
For further details contact : kalpanavmahadik@hotmail.com