Muscle-Sparing Approach for Recurrent Hydatidosis of the Thigh and Psoas: Report of a Rare Case
| Autor: | Salvatrice Gagliardo, Domenico Russello, Elia Pulvirenti, Gaetano La Greca, Maria Sofia |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty lcsh:Arctic medicine. Tropical medicine lcsh:RC955-962 medicine.medical_treatment Thigh Psoas Muscles Pelvis Echinococcosis Recurrence Medicine Humans Cyst Saline Right Thigh Infectious Diseases/Helminth Infections Symposium Groin business.industry lcsh:Public aspects of medicine Public Health Environmental and Occupational Health lcsh:RA1-1270 Middle Aged medicine.disease Surgery Infectious Diseases medicine.anatomical_structure business Tomography X-Ray Computed |
| Zdroj: | PLoS Neglected Tropical Diseases PLoS Neglected Tropical Diseases, Vol 5, Iss 1, p e840 (2011) |
| ISSN: | 1935-2735 1935-2727 |
| Popis: | A 46-year-old male shepherd presentedwith a mildly painful mass 4.5 cm indiameter localized at the right groin andthigh, diffuse edema involving the right leglasting for 2 weeks, and fever. The patienthad had eight previous operations fordiffuse hydatidosis with reported intraper-itoneal seeding, but further informationwas unavailable.Laboratory tests are shown in Table 1.An abdominal ultrasound (US) and aDoppler US of the right leg detected thepresence of multiple and partially confluentcysts localized up to the Scarpa’s triangle. Acomputed tomography (CT) scan detecteda multi-cystic 18-cm mass originating fromthe psoas muscle (Figure 1, I and II). Othercysts were localized deeply and behind themuscular aponeurotic plane of the femoralquadriceps and abductor muscles (Figure 1,III and IV). All these findings were sug-gestive of diffuse hydatidosis and the patientwas promptly operated on with a muscle-sparing approach, for which a writtenconsent was obtained.Piperacillin/tazobactam was adminis-tered from the date of admission to theday of surgery. Preoperative prophylaxiswith benzimidazole derivatives was notperformed due to the extent of the disease,the history of recurrences, and the need toperform the operation promptly to reducethe symptoms.At surgery, the retroperitoneum wasaccessed and tissues surrounding the cystswere covered with sponges soaked withhypertonic saline. The cystic content wasevacuated and the interior of the cyst wasrepeatedly washed with protoscolicides.Due to the tight adhesions with the peri-toneal sac, only the lateral-lower portionof the cystic wall could be resected. Nodaughter cyst was found. Subsequently,the right thigh was anteriorly incised andthe cysts were evacuated. The washingtreatment was repeated but extensive resec-tion was avoided to prevent any risk ofunnecessary damage.Histopathological examination did notdetect viable protoscolices and routinecultures performed to individuate otherpathogens were negative.A CT scan performed before dischargeshowed the integrity of the psoas muscle(Figure 2, I and II) and the lack of residualcysts in the thigh with conservation of themuscular structures (Figure 2, III and IV).The patient was discharged after 11 dayswith 6 months of administration ofmebendazole. Further investigations couldnot be performed because the patientmissed the planned follow-up. |
| Databáze: | OpenAIRE |
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