Primary hydatid cyst of gallbladder: A case report

Introduction: Hydatid cyst is a common clinical entity in India. Liver and lungs are the common organs involved. No organ is immune to infection. Case Report: We report a case of primary hydatid cyst of gallbladder presenting as a gallbladder lump. Conclusion: In endemic regions hydatid cyst should be considered in patients presenting with gallbladder lump. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 6 No. 7, July 2015. ISSN – [0976-3198] Int J Case Rep Images 2015;6(7):440–443. www.ijcasereportsandimages.com Kabiraj et al. 440 CASE REPORT OPEN ACCESS Primary hydatid cyst of gallbladder: A case report Pronoy Kabiraj, Shib Shankar Kuiri, Utpal De


INtrODUctION
Hydatid cyst in humans is an accidental dead end infestation caused by Echinococcus granulosus. It is endemic in sheep rearing countries. In India, Jammu and Kashmir is an endemic region though reports of hydatid disease has been reported from almost whole of the Indian subcontinent [1]. Liver (75%) and lungs (15%) are common sites of infection in humans [1,2]. Primary extrahepatic intra-abdominal hydatid cyst is a rare clinical entity. This article reports and reviews a case of primary gallbladder hydatid (Table 1).

cAsE rEPOrt
A 16-year-old female patient admitted suffering from intermittent mild pain in the right hypochondrium and epigastrium associated with nausea since six months. There was no history of fever or jaundice. Physical examination revealed mild tenderness in the right upper quadrant of the abdomen. On deep palpation a globular lump (4 cmx3 cm), moving with respiration was noted in the right hypochondrium. The upper margin of the lump was impalpable while the other margins were well defined. Murphy's sign was positive.
Base line hematological examination was unremarkable. Plain abdominal X-ray was normal. The ultrasound examination showed that her gallbladder was distended with a localised thickening of its wall. A single cystic lesion was noted inside the gallbladder lumen giving it an impression of double gallbladder. There was no image of gallstone.
An abdominal CT scan was performed showing inflammatory gallbladder wall with a cyst within cyst appearance ( Figure 1). Hepatic parenchyma and other abdominal organs proved absolutely normal.
Anti-Echinococcus antibodies were not found in serum. The diagnosis of primary hydatid cyst of gallbladder was made and surgery was decided. The patient underwent right subcostal laparotomy. Intraoperatively, the gallbladder was found to be tense and hugely  Figure 2). The wall appeared oedematous and inflamed. After proper precaution the gallbladder wall was opened ( Figure 3). A single cyst with germinal layer was delivered intact. No other cysts were found in the liver and peritoneal cavity. Cholecystectomy was performed. It permitted a total removal of the cyst without rupture. A peroperative cholangiography searching daughter cysts in the common bile duct proved unremarkable. The patient's postoperative course was uneventful and she was discharged on tenth postoperative day after stitch removal. The patient was put on albendazole (10 mg/kg) in divided doses. The histopathology confirmed the presence of hydatid cyst (Figure 4). At sixth month follow-up, the patient was well and had no recurrence of hydatid disease.
Univariate presentation of gallbladder hydatid include acute cholecystitis with cholangitis, gallbladder lump, obstructive jaundice or peritonitis with shock due to rupture. A combination of the above symptoms is not infrequent. Gallbladder hydatid with daughter cysts in the common duct producing obstructive symptoms may give rise to a false positive Courvoisier's law [2,[5][6][7][8][9]. So in endemic areas this should be included in the differential diagnosis of patients with obstructive jaundice. Abdominal sonography is highly sensitive and specific for diagnosing hydatid cyst but accurate extrahepatic organ localization is at times doubtful [5,8,9]. Computed tomography, and magnetic resonance imaging, are adjuncts to sonography for definitive diagnosis. Serological (ELISA) and hematological (eosinophilia) tests may clinch the diagnosis along with radiology [4,[6][7][8][9]. Cystoprostatectomy (cholecystectomy) is the treatment of choice [2-5, 8, 9]. Apart from the usual peroperative precautions gentle handling of the gallbladder is of utmost importance. An intraluminal rupture may    result in spillage into common bile duct. Manual handling instead of instrumental (application of Moynihan's clamps) holding of the gallbladder during dissection is warranted [1,7]. Cystic duct should be identified early and stay suture passed in order to prevent accidental spillage of contents into CBD in the event of rupture of cyst. Careful ligation of cystic duct and artery together with removal of gallbladder from liver bed along with a portion of the liver tissue prevents rupture and spillage.

cONcLUsION
In endemic countries, hydatid cyst should be considered in the differential diagnosis in patients presenting with gallbladder lump.

Edorium Journals: An introduction
Edorium Journals Team

But why should you publish with Edorium Journals?
In less than 10 words -we give you what no one does.

Vision of being the best
We have the vision of making our journals the best and the most authoritative journals in their respective specialties. We are working towards this goal every day of every week of every month of every year.

Exceptional services
We care for you, your work and your time. Our efficient, personalized and courteous services are a testimony to this.

Editorial Review
All manuscripts submitted to Edorium Journals undergo pre-processing review, first editorial review, peer review, second editorial review and finally third editorial review.

Peer Review
All manuscripts submitted to Edorium Journals undergo anonymous, double-blind, external peer review.

Early View version
Early View version of your manuscript will be published in the journal within 72 hours of final acceptance.

Manuscript status
From submission to publication of your article you will get regular updates (minimum six times) about status of your manuscripts directly in your email.

Most Favored Author program
Join this program and publish any number of articles free of charge for one to five years.

Favored Author program
One email is all it takes to become our favored author. You will not only get fee waivers but also get information and insights about scholarly publishing.

Institutional Membership program
Join our Institutional Memberships program and help scholars from your institute make their research accessible to all and save thousands of dollars in fees make their research accessible to all.

Our presence
We have some of the best designed publication formats. Our websites are very user friendly and enable you to do your work very easily with no hassle.

Something more...
We request you to have a look at our website to know more about us and our services.
We welcome you to interact with us, share with us, join us and of course publish with us.

Invitation for article submission
We sincerely invite you to submit your valuable research for publication to Edorium Journals.

Six weeks
You will get first decision on your manuscript within six weeks (42 days) of submission. If we fail to honor this by even one day, we will publish your manuscript free of charge.

Four weeks
After we receive page proofs, your manuscript will be published in the journal within four weeks (31 days). If we fail to honor this by even one day, we will publish your manuscript free of charge and refund you the full article publication charges you paid for your manuscript.