Laparoscopic Palanivelu-hydatid-system aided management of retrovesical hydatid cyst
A 55-year-old man presented with lower abdominal pain of 4 months duration. He had no urinary, bowel, or systemic symptoms. There were no abnormal physical or laboratory findings, no mass was palpable on a rectal examination. An X-ray of the abdomen showed the presence of a calcified mass around the right seminal vesicle []. A CT scan of the abdomen and pelvis confirmed an isolated well-defined lesion (6.5 × 5.6 cm2) in the right hemi pelvis with parenchymal calcification, internal septae, and debris suggestive of hydatid cyst; adherent to both the bladder and rectum []. His serology for Echinococcus (IgG by enzyme-linked immunosorbent assay system) was negative.\nWith a diagnosis of retrovesical hydatid cyst, the patient was started on oral albendazole (15 mg/kg/d in two divided doses) and scheduled for laparoscopic removal. In the supine position, four transperitoneal ports were used, a 12- mm camera port above the umbilicus in the midline, two pararectal ports (12 mm, 5 mm) below the umbilicus and one laterally placed (5 mm) in the right iliac fossa. The cranial-most part of the cyst that was directly visible on laparoscopy was thickly calcified and adherent to the sigmoid colon and the bladder. The ectocyst in this region was separated from these two structures circumferentially till a noncalcified part was identified on the anterior surface. Betadine-soaked gauze was packed around the cyst, and the PHS was inserted into the cyst thorough a 2-cm suprapubic incision. The contents of the cyst were aspirated, and hypertonic saline was instilled into the cavity as a scolicidal agent. The cycle of aspiration and flushing was repeated thrice before removing the PHS. The calcified cap of the ectocyst was laparoscopically excised, and the visualized cavity was again scraped and aspirated. The pelvis was washed with saline before exiting the abdomen.\nThe operative time was 3 h, and the blood loss was 120 mL. There were no complications, and the patient was discharged on day 2 with advice to continue albendazole for 3 weeks. He is symptom-free at 6 weeks follow-up.