Peritoneal hydatic cysts: a series of cases and the review of literature
Primary peritoneal hydatidosis is an extremely rare ( 2% of all intra-abdominal hydatid disease). Peritoneal hydatid disease is secondary to liver or splenic involvement following spontaneous rupture or accidental spillage during surgery. Methods: We made a retrospective study based on the analysis of the database of the I Surgery Clinic of the University Emergency Hospital „St. Spiridon ”from Iași, with peritoneal hydatid cyst, including all the data from the medical files. Between 1991 and 2021 a total of 18 patients were operated for primary (3) or secondary peritoneal cysts (15). During the same period, 1002 cases of hydatid cyst with various locations were treated in the Iasi Surgery Clinic: 805 abdominal (714 hepatic, 43 splenic, and 18 peritoneal) and 197 extra abdominal (thoracic, cervical, muscular, retroperitoneal, etc.). The incidence of hydatid diseases has decreased over time from 35 cases per year to 18 cases per year. In the year of the COVID pandemic (2020) the incidence decreased to 10 cases per year.Most of the patients with peritoneal hydatidosis were asymptomatic or had atypical symptoms. The diagnosis was based on the preoperative history, rupture of the cysts, serology, ultrasound and computer tomography. Open surgery was the procedure of choice (16 cases) with conservative (13 cysts) and radical (3 cysts) methods. The laparoscopic approach was performed in 2 cases of primary peritoneal hydatid cysts. Results: The outcome of surgery was good without postoperative mortality or severe morbidity and the recurrence rate was 22.2%. Conclusions: Peritoneal hydatidosis is a rare disease; it is important to prevent the disease. Clinical signs and symptoms are nonspecific for a long time.We suspect this diagnosis in the case of abdominal cystic tumors especially in endemic regions. The diagnosis is made based on the history of operated hydatid disease, clinical signs, imaging and immunological tests. Total surgical excision of hydatid cysts or partial perichystectomy after evacuation of the inactivated cyst is the chosen treatment. Proper perioperative medical treatment prevents recurrence. Long-term follow-up is necessary to detect and treat any recurrence.