Abstract

Introduction: Hydatid cyst, a common parasitic infection caused by Echinococcus granulosus, may get disseminated intra-abdominally after rupture of a hydatid cyst in the peritoneal cavity, producing secondary echinococcosis.

Case Description: A 49 years old male with generalised abdominal pain and low-grade fever. He was previously operated in 2013 for hepatic hydatid cyst from a midline laparotomy. Presently he was diagnosed with recurrence of liver hydatid disease with secondary peritoneal hydatidosis after detailed clinical and radiological evaluation. After starting oral Albendazole, open marsupialization of the liver hydatid cyst was donewith complete excision of multiple peritoneal hydatid cysts. Albendazole was continued for 3 months postoperatively and the patient was found to be disease-free in the 6-month follow up period.

Discussion: Peritoneal hydatidosis may be either primary or secondary. The secondary form is often due to spillage during surgery or rupture of a hepatic hydatid cyst. Peritoneal echinococcosis typically remains silent for years and the symptoms are polymorphous, depending on the location of the cyst.Ultrasonography and computed tomography are both excellent imaging modalities for the diagnosis.  The treatment of choice for localized peritoneal cyst is principally a careful and complete surgical excision after isolation with scolicidal soaked mops. Among non-operative options are chemotherapy and percutaneous treatment, depending on the features of the cysts.

Conclusion: Surgery for primary hydatid disease should be meticulously done, taking care to avoid spillage of scolices in the peritoneal cavity by isolating the cyst using Savlon soaked gauze and patient should be started on oral Albendazole therapy to prevent recurrence of hydatid cyst and secondary peritoneal echinococcosis.