A Giant Primary Adrenal Hydatid Cyst: The First Case Report in a Endemic Country: Algeria

Abstract

Introduction: Echinococcus is endemic in Algeria and Mediterranean countries and represents an important public health problem, but the localization of hydatid cysts in the adrenal gland is very rare. Case Report: We report a case of a voluminous primary hydatid cyst of the adrenal gland presented in our College Hospital of Oran, the second largest city in Algeria and the most important city in the western part of our country. The patient was a teacher. He was 46 years old, from a semi-rural region in the north of Algeria, with no animal contact. He complained of lumbar pain over the city in Algeria. Ultrasonography and abdominal CT scan showed a 14 cm cystic mass of the left adrenal gland and a spectacular mass effect on the kidney. Immunological test for echinococcus (Elisa) was positive. Surgical treatment consisted of resection of the protruding dome of the cyst by open retroperitoneal surgery. Diagnosis Visualization of hydatid cyst daughter and macroscopic examination of the resected piece. The cyst was multiloculated and filled with daughter cysts. The postoperative course was uneventful. No recurrence had occurred after months of follow-up. Conclusion: Primary Hydatid cyst in the adrenal gland is exceptional. Ultrasonography and tomodensitometry in conjunction with immunological tests can confirm the diagnosis. The cornerstone of treatment for this parasitic disease is prevention of parasite transmission. Surgical treatment for such a voluminous cyst has been performed in an open fashion and consists of peri-cystectomy of the protruding dome of the adrenal hydatid cyst after protection of the adjacent fields with compresses soaked in hydrogen peroxide and intracystic injection of hydrogen peroxide or concentrated saline into the cyst.