Presentation
Lower abdominal pain with fever. The clinical exam revealed suprapubic fistulae with a palpable mass in the left lower quadrant. No past history of surgery. The chest x-ray was normal.
Patient Data
A large well-circumscribed intraperitoneal cystic mass (9 x 7 cm) located in the left iliac fossa with thickened wall and focal peripheral calcification. It contains multiple daughter cysts of various size within the solid matrix, as well as air bubbles. An enhancing fistulous tract is noted, extending from this cystic mass to the adjacent anterior abdominal wall with suprapubic abscesses formation.
Note bilateral inguinal hernia of fat content.
Case Discussion
Case of a primary peritoneal hydatid cyst with spontaneous cutaneous fistulae. The main differential diagnosis given such an appearances is an infected fistulized intraperitoneal gossypiboma, which is excluded given no past history of surgery.
Secondary peritoneal hydatidosis is more frequent and usually secondary to rupture of hydatid disease of liver or spleen or spillage of cyst fluid during surgery.
Primary peritoneal hydatidosis is rare and the mechanism of dissemination is still unclear. Dissemination via lymphatics or systemic circulation is hypothesized.
Additional contributors: Z E Boudiaf MD, A Ramdani MD
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