Primary peritoneal hydatid cyst complicated with small bowel obstruction: a case report.

Introduction and importance: Peritoneal hydatidosis is a rare manifestation of echinococcosis, typically secondary to the rupture of hepatic or splenic hydatid cysts or accidental intraoperative dissemination. Herein, we report a rare case of small bowel obstruction caused by a primary peritoneal hydatid cyst, emphasizing the extreme rarity of primary peritoneal involvement leading to bowel obstruction. Case presentation: We report the case of an 87-year-old male presenting with acute small bowel obstruction. Clinical examination revealed abdominal distension and tympanism. Imaging identified small bowel dilation proximal to a right iliac fossa transitional point and a calcified-walled cystic mass. Emergency laparoscopy revealed dilated small bowel loops and a fibrous band tethering the omentum to the peritoneum at the site of a solid-cystic mass. Following conversion to laparotomy, the mass was resected, and cystotomy expelled hydatid material. Histological analysis confirmed the diagnosis of hydatid disease. Postoperative recovery was uneventful, and the patient was discharged on postoperative day three. Clinical discussion: Hydatid disease remains endemic in Mediterranean, African, and South American regions. Primary peritoneal hydatidosis is exceptionally uncommon, representing less than 2% of abdominal hydatid cases, and its presentation as small bowel obstruction is exceedingly rare. It may be caused by either compression of the bowel or a fibrous band. Diagnosis relies on clinical suspicion, imaging, and serology. Surgical excision remains the mainstay of treatment, ideally with complete removal to avoid recurrence. Conclusion: This case highlights the importance of considering hydatidosis in the differential diagnosis of an acute abdomen, particularly in endemic areas.