Ruptured and infected pelvic hydatid cyst with peri-appendiceal inflammatory involvement in an adolescent: laparoscopic management – a case report
Hela Oueslati, Aida Daib, Souha Laarif, Cyrine Saadi, Rabiaa B. Abdallah, Youssef HellalIntroduction:
Pelvic hydatid disease is uncommon, particularly in pediatric patients, and may mimic abdominal or gynecological conditions. Acute complications, such as rupture and secondary infection, may result in challenging diagnostic presentations and surgical emergencies.
Presentation of case:
We report a 15-year-old girl presenting with acute abdominopelvic pain and vomiting. Initial imaging revealed a large preuterine cystic mass (10.6 cm) without a clear digestive or adnexal origin, alongside a small hepatic cystic lesion. Given its presumed gynecologic origin and the delay in magnetic resonance imaging access, the patient was referred for further evaluation but was lost to follow-up. Three weeks later, she was readmitted with fever, worsening pain, and elevated inflammatory markers. Emergency laparoscopy revealed a ruptured, infected preuterine hydatid cyst containing purulent fluid and daughter membranes, adherent to the uterus and right adnexa. An inflamed appendix with marked peri-appendiceal changes was found in close contact with the cyst, suggesting peri-appendiceal inflammatory involvement secondary to local inflammatory extension. Laparoscopic management included cyst evacuation with scolicidal precautions, appendectomy, cavity drainage, and peritoneal lavage. The hepatic cyst was managed conservatively with a 3-month course of albendazole. No recurrence was observed at 1-year follow-up.
Discussion:
Pelvic hydatid disease is rare and diagnostically challenging. Rupture and superinfection may obscure the diagnosis. This case highlights peri-appendiceal inflammatory involvement secondary to local extension from an infected, ruptured pelvic hydatid cyst.
Conclusion:
Pelvic hydatid cysts should be considered in cystic pelvic masses in endemic areas. In selected cases and with meticulous scolicidal precautions, laparoscopy may be a safe and effective therapeutic approach.