Primary mesenteric hydatid cyst; a rare manifestation of hydatid disease through a case report and literature review

Abstract

Introduction and importance: Hydatidosis, a common zoonotic disease, especially in countries which are poorly developed, is not only capable of affecting a huge number of humans but also animals.

Case presentation: A 40-year-old female presented to our hospital complaining of the left flank and left upper quadrant pain increasing with exertion for three years. Physical findings revealed a firm lump in the left upper quadrant area extending to the left flank about (15cmx14.5 cm) in size. Abdominal CT scan reported a well defined low attenuating fluid density consistent with thick walled cystic lesion in the left upper quadrant, which is not separable from the lower pole of left kidney as well as pancreatic tail, showing significant mass effect over the left renal pelvis resulting in moderate dilatation of left pelvi-calyceal system superiorly. Our case was managed with the removal of laminated membrane of the cyst and followed by Mebendazole therapy.

Clinical discussion: The disease is commonly caused by Echinococcosis granulosus, the parasite mostly takes place in the liver (70 %) and in the lungs (25 %). In 13 % of cases the primary hepatic cyst raptures causing the formation of intraperitoneal cyst, however the primary intraperitoneal hydatid cyst (2 %) and the primary mesenteric hydatid cysts are very rare. Considering the possibility of hydatid cyst especially in the endemic regions is highly recommended because in these regions there are many diversities in the presentation. As surgical excision with subsequent Mebendazole therapy for four months is the proper treatment for these cases.

Conclusion: Primary hydatid cyst of the mesentery is rare even in the endemic regions. Thus, it's important to differentiate hydatid disease of abdomen from the other cystic lesions, occured in the abdominal cavity, specially in the endemic regions.

Keywords: Echinococcosis granulosus; Hydatid cyst; Hydatidosis; Mesentery.

Fig. 1

Coronal section of abdominal CT scan showing low attenuating well defined in the left upper quadrant of abdomen with mild hydronephrosis left pelvi-calyceal system.

Fig. 2

This horizontal section of abdominal CT scan indicates a well-defined cystic mass in the left side of the abdomen.

Fig. 3

Transverse section of abdominal CT scan indicating a thick-walled, well-defined, hypodense, cystic lesion attached to the tail of pancreas.

Fig. 4

Showing, Normal chest radiograph.

Fig. 5

Intra-operative image, showing Removal of Laminated Membrane of the cyst.

Fig. 6

Intra-operative image, showing the cyst was completely removed.