Simultaneous surgical treatment of multiple abdominal echinococcosis and benign pelvic organ tumours: a case report.

backgroundEchinococcosis of the liver is a parasitic infection that poses a significant healthcare challenge in endemic regions. The majority of cases present with either no clinical signs or non-specific ones, making differential diagnosis difficult until after the operation. Preoperative diagnostics rely mainly on computed tomography, magnetic resonance imaging, and ultrasound. The usual treatment for liver echinococcosis involves an operation, such as percutaneous intervention, surgical resection of the cyst as well as surrounding liver tissue, or major liver resection, followed by prolonged conservative treatment with Albendazole. Even though cases of simultaneous treatment of the echinococcosis and neoplastic lesions are present in the literature, they are scarce and the new data on the subject is of importance. A 61-year-old female patient presented to our clinic with chief complaint of abdominal pain. Upon physical examination, a palpable mass was discovered in the right ileac region along with hepatomegaly. Laboratory studies indicated the presence of an unspecified infection. An MRI of the abdomen revealed masses in both ovaries and cystic lesions in the liver and pelvis. The patient underwent surgical resection of cysts located both in the abdominal cavity and liver, as well as resection of surrounding liver parenchyma in S2 through S7 for echinococcosis and both-sided ovariectomy, hysterectomy, and omentum resection for lesions of the ovaries. The hepatic and abdominal cystic lesions were found to be of echinococcal origin, and the right ovary lesion was a mature teratoma even though preoperatively it was considered to be cancer. The patient is currently alive and well with no signs of recurrence after seven years.

conclusionAs such cases are rare, the medical documentation should be well described and analyzed for future reference. It is now considered to be possible to treat multiple cystic echinococcosis of the liver and free abdominal cavity along with potentially malignant lesions of the abdomen and pelvis - in our opinion survival rates should be similar to the rates of malignancy alone as radical surgical treatment of cystic echinococcosis remains effective and well accepted route of treatment. This rare case demonstrates and emphasizes an importance of simultaneous surgical interventions as well as correct preoperative suggestion of diagnosis.