El Bakouri Abdelilah, Fatine Amine, Eddaoudi Yassine, Bouali Mounir, El Hattabi Khalid, Bensardi Fatimazahra, Fadil Abdelaziz
Visceral Surgical Emergency Department, Faculty of Medicine and Pharmacy, Universitary Hospital Center Ibn Rochd, Hassan II University, Casablanca, Morocco.
Ann Med Surg (Lond). 2022 Sep 10;83:104606. doi: 10.1016/j.amsu.2022.104606. eCollection 2022 Nov.
Hydatidosis is a cosmopolitan parasitic disease which presents a real public health problem especially in endemic countries of which Morocco is part. The objective of the present work is to analyze the clinical, paraclinical, therapeutic, evolutionary and prognostic aspects of disseminated peritoneal hydatidosis with multiple localization.Peritoneal hydatidosis represents the whole of the phenomena due to :The seeding, essentially secondary, of the peritoneal serosa by Echinococcus Granulosus larvae, Peritoneal hydatidosis is characterized by its polymorphic symptomatology, and the diagnosis is based on a combination of epidemiological, clinical, biological and imaging findings.
We report a case of a particular form of peritoneal hydatidosis in the department of visceral surgery I of the ibn rochd hospital in casablanca.
Our patient was admitted for management of disseminated peritoneal hydatidosis. The clinical examination, apart from an epigastric crust, was unremarkable. The biological work-up showed a slightly disturbed liver balance and the hydatid serology was strongly positive. The preoperative diagnosis of HP was established by CT scan showing a supra- and sub-mesocolic peritoneal hydatidosis with a multi-cystic spleen and a liver with a type V segment V hydatid cyst measuring 4 cm by 6 cm.The treatment consisted of a total cystectomy of the hydatid cysts, almost 100 cysts with multiple peritoneal and parietal locations, one of which was fistulized in the skin, associated with a total splenectomy, retrograde appendectomy and a disconnection of the cholecysto-duodenal fistula with duodenal closure and a retrograde cholecystectomy associated with a choledecotomy with extraction of 3 stones at the level of the choledochus and drainage of the VBP by Kehr drain. The postoperative course was simple and the patient was discharged on the sixth day with an adjuvant treatment with albendazole for three months.Through this observation and in the light of the data in the literature, we were able to insist in our present work on the diagnostic difficulties generated by this unusual location of the hydatid cyst as well as the considerable contribution of imaging (CT++) allowing both a positive and very precise topographic diagnosis. We were also able to focus on surgical treatment as an indispensable pillar of the management of this disease as well as the increasingly fundamental role of medical treatment, particularly in the prevention of recurrences.
Peritoneal hydatidosis is a rare but serious complication of hydatid disease.The positive diagnosis is based on epidemiological, clinical, and paraclinical arguments represented essentially by CT scan.Early diagnosis and treatment of primary sites as well as optimal surgical management of peritoneal hydatidosis determine the prognosis.
包虫病是一种世界性的寄生虫病，是一个实实在在的公共卫生问题，在包括摩洛哥在内的流行国家尤为如此。本研究的目的是分析播散性腹膜包虫病伴多部位受累的临床、副临床、治疗、病情演变及预后情况。腹膜包虫病是由以下因素导致的一系列现象：细粒棘球绦虫幼虫主要通过继发性播散侵犯腹膜浆膜。腹膜包虫病症状多样，诊断需综合流行病学、临床、生物学及影像学检查结果。
我们报告了卡萨布兰卡伊本·鲁世德医院第一内脏外科收治的一例特殊类型的腹膜包虫病病例。
我们的患者因播散性腹膜包虫病入院治疗。临床检查除上腹部有瘢痕外，未见明显异常。生物学检查显示肝脏功能略有紊乱，包虫血清学检查呈强阳性。通过CT扫描术前确诊为肝包虫病，显示结肠系膜上下均有腹膜包虫病，脾脏有多发性囊肿，肝脏Ⅴ段有一个大小为4厘米×6厘米的Ⅴ型包虫囊肿。治疗包括对包虫囊肿进行全囊肿切除术，共切除近100个囊肿，分布于腹膜和腹壁多个部位，其中一个与皮肤形成瘘管，同时进行全脾切除术、逆行阑尾切除术，切断胆囊十二指肠瘘并关闭十二指肠，行逆行胆囊切除术，同时进行胆总管切开取石，在胆总管水平取出3颗结石，并通过凯尔引流管进行胆汁引流。术后过程顺利，患者于术后第六天出院，并接受了为期三个月的阿苯达唑辅助治疗。通过该病例观察并结合文献资料，我们在本研究中强调了包虫囊肿这种特殊位置所带来的诊断困难，以及影像学检查（CT++）在做出准确且精确的定位诊断方面的重要作用。我们还强调了手术治疗作为该病治疗不可或缺的支柱的重要性，以及药物治疗在预防复发方面日益重要的作用。
腹膜包虫病是包虫病一种罕见但严重的并发症。阳性诊断基于流行病学、临床及副临床依据，主要由CT扫描体现。对原发部位的早期诊断和治疗以及对腹膜包虫病的最佳手术管理决定预后。
