An extremely large primary omental hydatid cyst: report of a rare case
The case was an 82-year-old woman, with a body weight of 61 kg , who was referred to the emergency room with complaints of severe abdominal distention and dyspnea. She was admitted in the internal medicine ward with a primary diagnosis of ascites due to cirrhosis, based on the presence of the Caput medusae sign and clinical suspicion of ascites. She had a past history of eight abortions. She also mentioned an episode of abdominal distention about 40 years ago with a slow evolution. She also complained of a loss of the ability to walk during the last 10 years. During the last 2 years, her dyspnea has worsened gradually, so that she was unable to sleep in the supine position and obliged her to rest in lateral decubitus and semi-sitting positions. She had no other significant history of digestive problems during the recent years.\npattern B. Hard and sticky debris of cyst after aspiration.\nAbdominopelvic ultrasonography showed a heterogeneous hypoechoic lesion filling the whole abdominal and pelvic cavities. Hematologic, serologic and hepatic tests were reported to be normal. After a surgery consult, an abdominal and pelvic computed tomography scan (CT) with intra-venous (IV) contrast revealed a giant hypodense cystic mass of about 30x32 x43 cm located in the entire abdominopelvic cavity. It also revealed cystic wall calcifications in several areas that were extended to the abdominal skin border (). With the differential diagnostics of ovarian cystadenoma, mesenteric cyst and omental cyst, the medical team decided to perform laparotomy in which a large cyst was revealed that had displaced the intestines to the sides of the abdomen. There was an important cyst calcification near the left abdominal wall, of about 2x4 cm. Anterior wall of the cyst was covered by the greater omentum, with manifestations of a vascular pattern (). Cyst aspiration was performed and the sample was sent for pathological analysis. About 20 liters of cystic contents were aspirated. After decompression of the cyst, atrophy of the uterus, ovaries, stomach and spleen were observed. The posterior wall of the cyst adhered intimately and extensively to the mesentery, which prohibited the complete cyst release from the surrounding structures. The debris contained within the cyst was hard and sticky; therefore, the cyst was washed using Povidone-iodine 10% and the debris inside the cyst was removed (). Finally, we performed a partial cystectomy and ensured external drainage. After five days, the patient was breathing normally and her weight was 44 kg (17 kg weight loss) (). The pathology report confirmed a hydatid cyst in the sample of cystic wall, but smear and culture of cystic contents were negative.\nThe patient was discharged home and prescribed oral Albendazol with a dose of 15 mg/kg per day. After two weeks, the drain tubes were removed and she could walk without any help after 10 years and sleep in supine position after 2 years.