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| Year : 1986 | Volume
: 32
| Issue : 1 | Page : 46-48 |
Hydatid disease of urinary bladder (a case report).
Deodhar SD, Patel VC, Kirloskar MS
How to cite this article:
Deodhar S D, Patel V C, Kirloskar M S. Hydatid disease of urinary bladder (a case report). J Postgrad Med 1986;32:46-8 |
While hydatid disease of liver and lung is very common, hydatid cysts do occur, on rare occasions, in unusual sites; thus spleen, kidney, bones and muscles, skull and brain, spine, breast, thyroid, peritoneal cavity and retroperitoneum have all been involved.[2]
Recently, we had under our care at King Edward VII Memorial Hospital, Bombay, a case of hydatid cyst arising from the urinary bladder. The rarity of this case prompts us to present this report.
A 60 year old male patient was admitted on 3-2-85 with acute urinary retention of one day's duration; there were similar episodes of retention in the previous three years which had responded to catheterization. There was no history of pyrexia, pyuria, haematuria, and calciuria. There was no history of prolonged contact with sheep or dogs.
On examination, there was an intra-abdominal lump 10 cm x 15 cm in the hypogastric region. It was smooth, tender, tense, dull on percussion and immobile; it projected into the rectum, but there was no involvement of the rectal mucosa.
Catheterization was carried out but the physical findings remained unaltered. Plain X-ray of the abdomen showed a diffuse, soft tissue shadow in the lower abdomen without any calcification. I.V.P. showed a mass compressing the bladder on the superior and left aspect; [Fig. 1] both the ureters were displaced laterally. Cystoscopy showed mucosal congestion and cystitis with a diffuse mass projecting on the left side, but the bladder mucosa was normal. Cystogram confirmed displacement of the bladder anteriorly and to the right. Ultrasonogram showed multiple cystic areas arising from the posterior wall of the urinary bladder, its capacity: being markedly reduced. Liver scan and plain X-ray chest were normal. There was no significant eosinophilia. Casoni's test was positive. The rest of the investigations were within normal limits.
On exploration under general anaesthesia, a mass 15 cm x 10 cm was found arising from the posterosuperior wall of the urinary bladder. It was free from the rectum, sigmoid colon and loops of small intestine. Liver, spleen, kidney and rest of the peritoneal cavity were normal. After adequate isolation, the bladder mass was incised and was found to be filled with several daughter cysts; these were evacuated and the interior of the cyst was washed with 0.5% cetrimide solution.3 As it was not possible to excise the cyst in toto, marsupialisation was carried out. Post-operative recovery was uneventful. A repeat cavitogram showed progressive decrease in the size of the cavity. The opening into the cyst closed after 53 days.
The daughter cysts varied from 1 cm to 5 cm in diameter and contained clear fluid. Microscopic examination showed a lamellated wall with germinal epithelium on the inner aspect developing into scolices. [Fig. 2]. Histological diagnosis was hydatid cyst of the posterior wall of the urinary bladder.
Amir-Jahed et al in 1975[1] reported a series of 221 patients with hydatid disease, of whom 179 (81%) had single organ involvement and 42 (19%) showed involvement of multiple organs or sites. Liver, lung and spleen were the most common single sites. Amongst multiple organs involved simultaneously, liver was outstanding and outnumbered all other organs and sites in 95.24% of cases. There was only one case involving the urinary bladder in their series.
Tovey[4] reported a patient with solitary hydatid disease of the urinary bladder. The manner of presentation was similar to that of our case. The principle of surgical therapy in the management of hydatid disease is total excision of the cyst or cysts as much as is compatible with ease and safety.[1] In difficult situations where resection is not possible, marsupialisation of the cyst after thorough evacuation of all daughter cysts is usually carried out.[1],[4] A preliminary instillation of formalin or cetrimide is advocated.[3],[4]
Thanks are due to the Dean of K.E.M. Hospital, Bombay, for permission to publish this case report.
| 1. | Amir-Jahed, A. K., Fardin, R., Farzad, A. and Bakshandeh, K.: Clinical ecchinococcosis. Ann. Surg., 182: 541-546, 1975.  |
| 2. | Joshi, M.: "Surgical Diseapes in the Tropics." Macmillan India Ltd. Bombay, Calcutta, Madras, 1982, pp. 151-169. |
| 3. | Maingot, R.: "Abdominal Operations. 7th Edition, Vol. 1. Appleton Century Crofts, New York, 1980, pp. 1329-1348. |
| 4. | Tovey, F. I.: A hydatid cyst presenting as a large lower abdominal tumour. Ind. J. Surg., 27: 670-671, 1965. |
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