Acute Urinary Retention due to Primary Pelvic Hydatid Cyst: A Rare Case Report and Literature Review

Abstract

A 58-year-old male patient was admitted in surgical ward with retention of urine for the last 16-hours. He had a history of difficulty in passing urine for last three years along with sense of incomplete bladder evacuation and increased frequency for the same duration. Abdominal examination revealed that suprapubic bloating was due to full bladder, which was tender on palpation and dull on percussion. On per rectal examination, a smooth cystic extraluminal mass was felt anteriorly in the rectovesical pouch without any rectal mass or prostatic enlargement. He was immediately catheterised to relieve his discomfort. There was no history of burning micturition, fever or significant weight loss in the recent past. He had no history of surgery, instrumentation or trauma to the lower urinary tract and there was no history of taking regular medicines (like NSAIDs) which can cause bladder outflow obstruction. General physical examination of the patient was unremarkable and examination of the other systems including neurological system was essentially normal. His complete blood count, serum urea, creatinine and electrolytes, liver function tests and urinalysis were essentially normal. Ultrasound examination (USG) revealed a large, encapsulated SOL with both solid and cystic components, measuring 7.8×7.4×7cm in the pelvis, posterior to urinary bladder. On colour flow study no vascularity was seen in the lesion. There was no lesion in the liver or any other abdominal organ, and also no abnormality detected in prostate and seminal vesicles. Contrast enhanced computed tomography (CECT)scan of the abdomen and pelvis revealed a 8.3×8×7.5 cm, well defined, multilocular, non-enhancing lesion having typical cartwheel appearance occupying the rectovesical pouch of Douglas pushing the rectum and anal canal backward and urinary bladder forward. Radiological examination of chest was normal. Flexible cystoscopy revealed an impression of the mass on posterior wall of urinary bladder. There were no duplications, ureterocoele or diverticule on intravenous urogram. Provisional diagnosis of primary pelvic hydatid disease was made based on aforesaid findings, but hydatid serology (serum anti-echinococcus granulosus IgG antibody on ELISA) was not suggestive. Albendazole (10mg/kg/day) was given to the patient Causes of urinary retention in old men include benign prostatic hyperplasia, prostatitis, prostate cancer, Scarring of the urethra or bladder neck as a result of injury or surgery, use of certain medicines particularly NSAIDs and opioid analgesics, constipation and neurogenic bladder. When the above common causes are not quite obvious by clinical examination and relevant investigations, then it is necessary to think of other rare diseases. It is with the above in our mind that a case of bladder outflow obstruction due to a large primary retrovesical hydatid cyst is herein reported in a 58-year-old man. Ultrasonography (USG) and Contrast Enhanced Computed Tomography (CECT) scan of the abdomen and pelvis of the patient revealed a large, mu...

A Fatal and Rare Case of Hydatid Cyst in the Pouch of Douglas

“…4,5 Most hydatid cysts present with abdominal pain, nausea, and jaundice, considering that liver is the most common site (59-75%). 6 A few patients have presented with a slow-growing occipitocervical mass, a painful mass growing in the left lateral side of the neck, and left gluteal pain and limb weakness, for a cyst in the cervical region, 7 the supraclavicular region, 8 and in the left deep gluteal muscle, 9 respectively. These are the rare presentations of hydatid cyst that have been reported.…”

“…Other rare sites include kidney (3%), musculoskeletal system (1-4%), brain (1-2%), and pelvis (0.2-2.5%). 6,[10][11][12] Pelvic hydatid cysts can present as obstructive uropathy, infertility, and irregular menses, and can be either primary or secondary. Primary hydatid cysts can be further rare and are seen when a primary cyst undergoes rupture and spontaneous resolution, but the contents can enter circulation and lead to another cyst, which is now called the primary cyst.…”

Isolated pelvic hydatidosis: A rare presentation of a common disease

“…USG and CECT scan may aid in determining exact location and nature of cystic mass in pelvis and also exclude hydatid cyst of any other organ. Gharbi classification on USG is well accepted even for primary pelvic hydatid cyst [8] . Combination of surgery and albendazole therapy are useful modalities of treatment.…”

Huge Isolated Retrovesical Hydatid Cyst Affecting a Little Girl

“…Sagittal fast spin-echo T2-weighted MR image clearly identifies small cystic lesions representing daughter cysts [14]. The Dévè's classical theory states that fissuring or rupture of a primary hepatic, splenic or mesenteric cyst may seed its contents to the abdominal cavity, leading to a new lesions, while the primary cyst may heal and disappear, leaving behind a scar that may not detected by any diagnostic tools [9,11,15]. Haematogenous or lymphatic dissemination is another theory tried to explain the absence of the primary visceral lesion, and the absent evidence of peritoneal seeding [9,11,15].…”

“…The Dévè's classical theory states that fissuring or rupture of a primary hepatic, splenic or mesenteric cyst may seed its contents to the abdominal cavity, leading to a new lesions, while the primary cyst may heal and disappear, leaving behind a scar that may not detected by any diagnostic tools [9,11,15]. Haematogenous or lymphatic dissemination is another theory tried to explain the absence of the primary visceral lesion, and the absent evidence of peritoneal seeding [9,11,15]. Other hypothesis said that the larva may remained in the rectal ampulla and migrated through the haemorrhoidal vessels to reach a perirectal or retrovesical location [16].…”