Ghulam Mustafa Nandwani, Kamran Ahmed Malik, Naima.
Infrequent Primary Sites for Hydated Cysts: Case Reports.
J Surg Pak Jan ;6(4):36-7.

Hydatid disease can occur any where in the body. It is very rare in muscles. We present two cases to emphasize that hydatid disease should be kept in mind in all cystic lesions of the body; especially in endemic areas. In Pakistan breaking of chain between primary and secondary hosts for E granulosus is not very effective; poor surroundings of slaughterhouses and use of natural fertilizers are the main culprits.

CASE NO. 1: A 50 years old man presented in the out-patients Department with complaints of vague abdominal pain for 6 months. There was no history of trauma or fever though sometimes he was constipated. Examination revealed a cystic retroperitoneal mass 5x7 cm in size just to the left of umbilicus. His haemoglobin was 15G/dl, TLC 6500 with Eosinophils 1%. Ultrasound abdomen revealed a cystic mass between the left kidney and pancreas that was suspicious of pancreatic pseudo cyst or renal cyst. His CT abdomen showed 10x8 cm cyst between the upper pole of left kidney and left psoas muscle with compression effect on the descending colon. Exploratory laparotomy concluded hydatid cyst arising from the left psoas muscle which was later proved by biopsy. Rest of the viscera were normal. Total hospital stay was 4 days with unremarkable post-operative recovery. Currently, he is in followup for the last 6 months and ultrasound abdomen and chest X-ray are normal.

CASE NO. 2: A 16 years old boy presented in accident and emergency department with recurrent swelling at right glutal region along with fever for the last 8 years. He had gone through incision and drainage and wound debridement couple of times for this complaint. All the reports of his draining fluid were negative for culture. Examination revealed 3x2inch swelling at right glutal region with multiple openings discharging thin plus. His haemoglobin was 14G/dl, TLC 12000, N 70 and E 1.Sinogram showed a cavity reaching up to the iliac bone. It was decided to explore the sinus. Peroperatively there was a thick walled cavity containing clear fluid with multiple small daughter cysts. Cavity was washed with hypertonic saline solution, deroofed and filled with omentum. Albendazole 10 mg/kg/day started postoperatively. Biopsy confirmed the diagnosis of hydatid cyst. His postoperative recovery was unremarkable. Total duration of hospital stay was 7 days. Followup ultrasound abdomen and chest X-ray are normal.

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