IPEG 2018 - Treatment of an Isolated Renal Hydatid Disease

Thank you for the opportunity. I have nothing to disclose. Renal involvement of hidraid disease is extremely rare, varying an incidence of 2 to 4%, almost always accompanying neighboring organs. Isolated renal hydroidosis is an even rarer incident disease. A 15-year-old girl presented with recurrent abdominal pain for more than 2 weeks and a history of calcified oval mass 9 x 7 millimeters in size visualized on her right hypochondrium during plain X-ray. Abdominal ultrasound and MRI revealed a thick-walled renal 8 x 6 x 6 millimeter lesion neighboring posterior segment of the right liver lobe and heterogeneous in appearance, including regular bordered isoechoexiss. The image was compatible with Stage 2 echinococcal hidarid disease. A laparoscopic intervention was performed one month later while under albendazole treatment. Upon initial inspection, severe inflammation accompanying dense adhesions between the liver and cyst was noted. The colon and the liver was carefully reflected away from the cyst wall by dissecting these adhesions. The surgical field was packed with 10% betadine soaked sponges and irrigated intermittently during operation. The dense, thickened wall was opened using hook cutlery after initial irrigation with hypertonic saline through a large breveris needle. The enlarged cavity was repeatedly irrigated and aspirated with hypertonic saline until all protocells and the fragile germinal membrane was completely removed. Unroofing was performed by wide excision of the cyst wall. No drain was placed in the residual cavity. The patient was discharged 48 hours after surgery in good health. Four months later, control ultrasound revealed fluid collection at the operative field. Approximately 200 mLs of degenerated fluid with no scholial material was aspirated, disfavoring recurrence of echinococcosis. The catheter was removed following alcohol ablation. Albanazole therapy was discontinued for 12 months with acceptable tolerance. The patient is under follow-up and doing well for 18 months with good collaboration. Organ sparing laparoscopic drainage is a beneficial approach for the patient due to the benign nature of the disease. Successful interventional radiology additionally offers safe treatment of a post-operative collection, further sparing the patient from unnecessary surgery.