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| Year : 1989 | Volume
: 35
| Issue : 1 | Page : 57-8 |
Primary echinococcal cyst of the broad ligament (a case report).
AA Kriplani, AK Kriplani
Correspondence Address:
A A Kriplani
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0002585340 
Keywords: Adult, Case Report, Echinococcosis, diagnosis,pathology,surgery,Female, Human, India, Ligaments, Uterus,
How to cite this article:
Kriplani A A, Kriplani A K. Primary echinococcal cyst of the broad ligament (a case report). J Postgrad Med 1989;35:57 |
| :: Introduction | |  |
Hydatid disease, the larval form of the tapeworm Echinococcus granulosus, most commonly affects liver and lungs and sometimes bones. The pelvic organs in females are rarely the primary site of cyst formation.[2],[3],[5] Bickers[2] after reviewing 532 cases of hydatid disease from an endemic area over a 20 year period, recorded 12 instances with hydatid cysts in the pelvis, only 2 of which were in the broad ligament; an incidence of 0.37 percent. We report a case of primary hydatid cyst of the broad ligament because of its rarity.
| :: Case report | | |
A 34 year old Hindu female from Ajmer district of Rajasthan was admitted with a painless, progressively increasing lump in the lower abdomen for the last 12 months. There were no urinary, gastro-intestinal or constitutional symptoms. There was no history of association with a pet-dog or farm animals. She had 4 full term normal deliveries; the last being 3 years back. Her menstrual cycles were regular, last period was 20 days back. She did not have tubal ligation earlier.
General examination of this averagely built lady was unremarkable except mild anaemia. An intra-abdominal, nontender, smooth, uniformly cystic, rounded lump arising from the pelvis was felt equivalent to the size of 32 weeks pregnancy. There was no other mass or organomegaly. Per speculum examination was normal. The mass was felt high up in the right fornix vaginally; the uterus being deviated to the left.
Routine blood chemistry was within normal range except mild anaemia (Hb 9.1 Gm/dL). Roentgenogram of the abdomen and chest were also normal. With the diagnosis of an ovarian cyst, right lower paramedian laparotomy was performed under general anaesthesia. A cyst containing clear transparent fluid was seen on the right side with the Fallopian tube More Details stretched over it (See Fig. 1 on page 58A). The cyst could not be delivered into the wound like an ovarian cyst. It was burrowing into the retro-peritoneum pushing the :caecum upwards. Right ovary could not be identified separately. Left adnexa and uterus were normal.
After incising the posterior parietal peritoneum and dividing the infundibulo-pelvic ligament, the cyst was mobilised. Posteriorly right ureter was coursing along with the wall and was safeguarded. The entire cyst along with the right fallopian-tube was removed. Palpation of liver and the rest of the abdomen did not reveal any other cyst.
Examination of the specimen revealed right ovary lying on the upper medial wall of the cyst (See Fig. 2 on page 58A) which measured around 25 cm x 17 cm. The cyst was unilocular, contained clear fluid and was lined by laminated membrane (See Fig. 2 on page ...). Histopathology confirmed the diagnosis of Echinococcal cyst. Recovery was uneventful. The patient is well after 10 months.
| :: Discussion | | |
Echinococcal disease of the female pelvis is rare in gynaecological practice. It accounted for 0.3 percent of all gynaecological laparotomies in an endemic area like Lybia.[6] Isolated pelvic hydatid disease is still uncommon[3],[5] since pelvic hydatid disease is usually secondary to previous surgery[2],[3],[6] or spontaneous ruptures and most patients have co-existent or previous cysts elsewhere, commonly the liver.[2],[3]
Most common presentation is a pelvic mass of varying size suggesting ovarian tumor.[4],[6],[7] The most important factor in the diagnosis is the awareness of the possibility of hydatid disease which should always be kept in mind in the differential diagnosis of any cystic pelvic mass. Plain radiograph may demonstrate calcification in the wall of the cyst. A number of ultrasound and CT features have been outlined[7] e.g. multilocular appearance, a fluid level from hydatid sand, and the ultrasonic 'water-lily' sign. However, they may not be always helpful, particularly in a unilocular cyst.[3] The scan in suspected hydatid disease should include the whole abdomen from liver to pelvis and a chest radiograph also be obtained. Casoni's intra-dermal test (CIT) and the indirect haem-agglutination (IH) test are reported to be positive in a variable number of patients.
Surgical removal is the usual treatment. Single cysts are not difficult to excise. Excision of multiple cysts may be difficult because of adhesions. In younger women, even in those with multiple cysts, every effort should be made to preserve reproductive organs. Spillage of the contents should be avoided by all means. Operating field should be meticulously packed with guaze soaked with scolicidal agent (formaline, 20% hypertonic saline, hydrogen peroxide). Mebendazole is a useful scolicide and can be used as an adjunct to surgery or in patients who are unsuitable for surgery. The dose in 40 mg/kg orally in divided doses for 21-30 days.
| :: References | | |
| 1. | Beggs, I.: The radiological appearances of hydatid disease of the liver. Clin. Radiol., 34: 555-563, 1983.  |
| 2. | Bickers, W, M.: Hydatid disease of the female pelvis. Anger. J. Obstet. & Gynaecol., 107: 477-483, 1970. |
| 3. | Clements, R. and Bowyes, F. M.: Hydatid disease of the pelvis. Clin. Radiol., 37: 357-7, 1986. |
| 4. | El-Tannir, A. D. and Fahmi, K. J.: Pelvic hydatid cysts. J. Obstet. Gynaec. Brit. C'Wlth., 74: 592-595, 1967. |
| 5. | Kalogeris, K. G., Christoforidis, L. I. and Milioudis, N. M.: Primary retroperitoneal pelvic echinococcal cyst. J. Urol., 135: 1235-1236, 1986. |
| 6. | Rahman, M. S., Rahman, J. and Lysikewicz, A.: Obstetric and gynaecological presentations of hydatid disease. Brit. J Obstet & Gynaecol., 89: 665-670, 1982. |
| 7. | Singh, R. S. and Sahay, S.: Retroperitoneal primary hydatid cyst of pelvis. J. Ind. Med. Assoc., 83: 64-65, 1985. |
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