A rare presentation of hydatid cyst in abdominal wall: case report

Abstract

Echinococcus species cause hydatidosis, which is a verminosis. Echinococcus vogeli results in polycystic hydatid disease, and wild dogs are the definitive hosts. In fact, wild dogs and rats are the most common hosts. The transit of Echinococcus eggs through the liver and lungs is hypothesized to result in hydatid cyst formation in the subcutaneous tissue. In 1.5 percent of patients with hydatidosis, hydatid cysts of the subcutaneous tissue have been documented. They ranged from 0.6 percent to 2.6 percent. We here report a case of hydatid cyst of the abdominal wall which was surgically treated. A 30-year-old lady had been experiencing pain associated with lump in her right lower abdomen for three months. On clinical examination, an enlargement in the left side measuring 4 x 3 cm was discovered. Imaging was performed preoperatively to rule out other differential diagnoses. Ultrasound was performed, followed by computed tomography and magnetic resonance imaging, which revealed multilocular cystic mass measuring 9 x 8.5 x 4.7 cm along the right lower anterior abdominal wall muscles (with cysts inside cysts), which suggested hydatid cyst. Histopathology confirmed the diagnosis of hydatid cyst, after the mass was surgically removed. Treatment with albendazole was continued. Hydatid cyst of the subcutaneous tissue is uncommon, with only a few occurrences recorded in the literature. This study describes a case of hydatid cyst in an uncommon place. Imaging confirmed the diagnosis, and the tumour was surgically removed. It ruptured during surgery and was successfully treated with hypertonic saline and albendazole. Then it was adequately managed. Given that subcutaneous hydatid cyst is rare, it's vital to keep in mind that it can be a possible cause of abdominal wall mass. Specific imaging test is essential to correctly locate and remove it. It must be treated with anthelmintic before surgery, in order to reduce the risk of contamination due to cyst rupture during surgery. Subcutaneous hydatid cyst should be considered one of the differential diagnoses for soft tissue masses, in particular in patients living in endemic areas. To rule out alternative possibilities, proper imaging test is essential. The treatment of choice is complete excision.