A 59-year-old Bosnian male presented with abdominal discomfort. A 20 × 10 cm2 suprapubic mass was palpable. An abdominal ultrasound scan (US) revealed a large complex pelvic mass, subsequent abdominal and pelvic computed tomography (CT) revealed multiple complex peritoneal cysts suggestive of hydatid disease (Fig. ).\nAs a child he reported frequent contact with livestock and dogs. Upon military conscription, aged 17, investigations revealed a pulmonary mass, resection of which confirmed echinococcosis. Five years later, he was diagnosed with splenic hydatid disease culminating in splenectomy. The multiple large cysts and daughter cysts now seen on his CT were presumed secondary to spillage and peritoneal seeding of hydatid cysts during his splenectomy 37 years prior.\nHe commenced Albendazole for 9 weeks prior to planned surgical resection. During laparotomy, one pelvic and four abdominal cystic structures were discovered. The pelvic cyst was sizeable and densely adherent to the bladder anteriorly and rectum posteriorly. As the cyst entered the true pelvis dissection proved problematic, as such the cyst was surrounded by hypertonic saline soaked packs to inhibit contents spillage. Four stay sutures were placed into the cyst wall and a cystostomy performed. The contents was judiciously evacuated (Fig. ). Once decompressed, the cyst was sutured closed and resected (Fig. ).\nHistology showed hydatid cysts and a diagnosis of EG was postulated. He completed a 7-day post-operative course of Praziquantel and 6 months of Albendazole. One year post-surgery repeat CT and MRI abdomen and pelvis show no recurrence.
A 62 year old Tunisian male was hospitalized for exploration of abdominal distension in the preceding two months with progressive aggravation. The patient had no history of trauma, surgery or systemic disease earlier. The patient had no history of trauma, prior surgery or systemic disease. Physical examination found ascites without any other abnormality. The ascitic fluid was thick and yellow with high level of lipids. Because the ascites was so massive and chylous, without any sign of hepatic, cardiac or nephrological disorder, tuberculosis or neoplasic causes were suspected. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity with associated with many intraperitoneal cysts with a scalloping on the liver (Figure ). It showed also a heterogeneous cystic lesion in the segment II of the liver measuring 3.5 × 2.5 cm. The biliary ducts have a normal calibre. Abdominal computed tomography (CT) before and after intravenous administration of contrast agent revealed in addition a fat infiltration and a thickening of the peritoneum (Figure ). Thus an intraperitoneal rupture of a hydatid cyst was suspected and an emergency laparotomy was performed. Yellow serous fluid (2000 ml) was noted, containing many daughter vesicles disseminated through the peritoneal cavity. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface (Figure ). After a partial cystectomy, the cyst pouch was irrigated with hypertonic saline (3%), and the peritoneal cavity was washed with isotonic saline for 10 to 15 minutes. After surgery, the patient was started on albendazole (10 mg/kg) for three months.