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CASE SNIPPET
Year : 2012  |  Volume : 58  |  Issue : 3  |  Page : 215-216

Hydatid disease mimicking urinary tract infection


1 Department of Surgery, University Hospital of Larissa, Viopolis, Larissa, Greece
2 Department of Radiology, University Hospital of Larissa, Viopolis, Larissa, Greece

Date of Web Publication26-Sep-2012

Correspondence Address:
D Zacharoulis
Department of Surgery, University Hospital of Larissa, Viopolis, Larissa
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.101409

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How to cite this article:
Sioka E, Rountas C, Zacharoulis D. Hydatid disease mimicking urinary tract infection. J Postgrad Med 2012;58:215-6

How to cite this URL:
Sioka E, Rountas C, Zacharoulis D. Hydatid disease mimicking urinary tract infection. J Postgrad Med [serial online] 2012 [cited 2019 Nov 17];58:215-6. Available from: http://www.jpgmonline.com/text.asp?2012/58/3/215/101409


A53-year-old male was admitted to the emergency room reporting urinary frequency. He stated that he wakes up at least three times to urinate during the night. His medical history included liver hydatidosis treated by deroofing of the cyst 24 years ago. Physical examination was unremarkable including rectal and prostatic exam. Laboratory profile was normal including urine analysis. Abdominal computed tomography (CT) scan with intravenous contrast agent injection revealed a 3.4-cm hypoattenuating, unilocular lesion at the anterior surface of the upper pole of the spleen. At the pelvis, a multilocular lesion was demonstrated, 10.5×13×9 cm in size, hypoattenuating, without contrast enhancement. The lesion was located to the rectovesical space compressing and dislocating the urinary bladder and the sigmoid colon [Figure 1].
Figure 1: Hypoattenuating, solitary lesion on the anterior surface of the upper pole of the spleen (white arrow). Additional large hypoattenuating, multilocular lesion located to the rectovesical space (black arrow), compressing and dislocating the urinary bladder and the sigmoid colon without contrast enhancement

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In the operating room, a large hydatid cyst was identified in the rectovesical space [Figure 2]a. Multiple gauzes saturated with hypertonic saline were placed around the surgical field. Then the cyst was mobilized from the surrounding tissues. Although the dissection was labor due to dense adhesions, there was no need for bowel or bladder excision and the cyst was removed intact. The small splenic cyst was approached through the lesser sac and deroofing was performed using the Harmonic scalpel [Figure 2]b. Again soaked gauzes with hypertonic saline were used to protect the surrounding tissues from spillage. The postoperative period was uneventful and the patient was discharged on the sixth postoperative day. Subsequently, albendazole was administered for three months postoperatively. Abdominal CT one year postoperatively reveals no recurrence.
Figure 2: (a) Hydatid cyst of the retrovesical space; (b) Hydatid cyst of the spleen. 1: lower pole of spleen, 2: stomach, black arrow: hydatid splenic cyst

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Dissemination of echinococcus may be a possible complication and not just a consequence of surgery. Dissemination is usually a consequence of the disease and its spread. Clinical presentation ranges from no symptoms to acute abdomen in case of rupture. [1],[2] Involvement of the urinary bladder is extremely rare. In our case, the cyst was retroperitoneal, abating the bladder, mimicking urinary frequency. Diagnosis may be performed several years postoperatively, as in the case illustrated.

The WHO Informal Working Group on echinococcosis classification groups the hydatid cysts according to the biological activity into "cystic lesion" (CL) stage (undifferentiated), active (CE1 and 2), transitional (CE3) and inactive (CE4 and 5). CE1 are unilocular unechoic cystic lesions with double line sign. CE2 are multiseptated, "rosette-like" "honeycomb" cysts. CE3 belongs to transitional form and is subdivided into CE3A (cysts with detached membranes (water-lily-sign)) and CE3B (daughter cysts in predominantly solid matrix). CE4 are heterogeneous hypoechoic/hyperechoic cysts without daughter cysts and CE5 are calcified solid cysts, both being classified as inactive. [3],[4],[5]

Retroperitoneal cysts are related to previous hepatic hydatid surgery (12%). Differential diagnosis involves the mesenteric cyst or intestinal duplication cysts. Regarding the hydatid cyst of the minor pelvis, multiple daughter cysts were found to be enclosed in the mother cyst. The surrounding fluid had higher attenuation providing the imaging pattern of "rosette" appearance. [6] Spleen is involved in abdominal echinococcosis in a percentage ranging from 0.5-6%, while the recurrence rate after surgical therapy of hepatic echinococcosis ranges from 6.8-22.3%. [7]

Surgical interference serves as the gold standard of treatment. Surgical strategy embraces radical removal of all cysts focusing firstly on the complicated cysts. Conservative treatment such as deroofing is indicated for uncomplicated cysts of the spleen. Medical treatment should be administered. Albendazole is preferred in doses of 10-15 mg/kg per day for three months. [3],[8] Close follow-up is essential due to the disease's unpredictable natural history.

Consequently, disseminated hydatid disease should be suspected in a patient with previous surgery for echinococcus. The presentation may be atypical.

 
 :: References Top

1.El Malki HO, El Mejdoubi Y, Mohsine R, Ifrine L, Belkouchi A. Intraperitoneal perforation of hepatic hydatid cyst. Gastroenterol Clin Biol 2006;30:1214-6.  Back to cited text no. 1
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2.Karakaya K. Spontaneous rupture of a hepatic hydatid cyst into the peritoneum causing only mild abdominal pain: A case report. World J Gastroenterol 2007;13:806-8.  Back to cited text no. 2
    
3.Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010;114:1-16.  Back to cited text no. 3
    
4.Brunetti E, Junghanss T. Update on cystic hydatid disease. Curr Opin Infect Dis 2009;22:497-502.  Back to cited text no. 4
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5.Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: State of the art, problems, and perspectives. Am J Trop Med Hyg 2008;79:301-11.  Back to cited text no. 5
[PUBMED]    
6.Ilica AT, Kocaoglu M, Zeybek N, Guven S, Adaletli I, Basgul A, et al. Extrahepatic abdominal hydatid disease caused by Echinococcus granulosus: Imaging findings. AJR Am J Roentgenol 2007;189:337-43.  Back to cited text no. 6
    
7.Yardimci S, Ulas M, Surmelioglu A, Bostanci EB. Splenic recurrence of liver hydatid cyst and spleen preserving therapy. Singapore Med J 2011;52:223-5.  Back to cited text no. 7
[PUBMED]    
8.Dziri C, Haouet K, Fingerhut A, Zaouche A. Management of cystic echinococcosis complications and dissemination: Where is the evidence? World J Surg 2009;33:1266-73.  Back to cited text no. 8
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