ISOLATED LARGE RENAL HYDATID CYST PRESENTING WITH HYDATIDURIA: A CASE REPORT

Renal hydatidosis represents only 2-3% of hydatid disease. Hydatid disease is a cyclozoonotic parasitic infestation caused by the cestode Echinococcus granulosus. Isolated renal involvement is extremely rare. We report a rare case of isolated left renal hydatid cyst in a 55-year- old female working as a farmer, who presented with vague abdominal pain and hydatiduria. Exploratory laparotomy was done, total excision of the cyst and pericystectomy was done. Diagnosis was confirmed by histopathology. Postoperative follow-up of the patient for six months showed the patient to be disease free. INTRODUCTION: Cystic echinococcosis (hydatidosis) is a parasitic disease caused by the larval form of Echinococcus granulosus. It is a common disease in specific regions. It is endemic in most sheep- raising countries in Asia, Europe, South America, New Zealand and Australia where sheep, dogs and humans live in close contact. (1,2) The guts of dogs and other carnivorous animals represent a definitive host for the adult worm. Humans become an accidental intermediate host by ingesting Echinococcus eggs. The liver is the most commonly involved organ, followed by the lungs. Renal involvement is very rare affecting up to 1.9% of patients.(3) However, a preoperative accurate diagnosis is important to provide appropriate antihelmentic treatment, take intraoperative precautions preventing parasite dissemination and possibly avoid unnecessary nephrectomy. (4) CASE REPORT: A 55-year-old female patient presented with vague abdominal pain of two year duration, insidious in onset, slowly progressive and dull aching in type. She had a history of intermittent passage of small, white, grape-sized, balloon-like structures in the urine (hydatiduria) for last two months. There were no other symptoms associated with the pain. General physical examination revealed no abnormality and systemic examination revealed a large ballotable mass in the left hypochondrium and lumbar region. Routine blood examinations were normal. The X-ray of the chest was normal. Ultrasonography of the abdomen picked up a cyst in the upper pole of the right kidney, measuring 25 cm in the largest dimension. Rest of the urinary system was normal. A computed tomography (CT) scan of the abdomen was done and displayed a large multiloculated cystic lesion at the upper pole of the left kidney (Figure 1). There were no other lesions in abdominal. A diagnosis of isolated left renal echinococcosis was made. The patient was started with albendazole. After four weeks, the patient underwent exploratory laparotomy under general anesthesia through midline incision, a large cyst involving the upper pole of the left kidney was noted (Figure 2), and fluid was aspirated and sent for analysis. Peritoneal cavity packed with hypertonic saline soaked mops. The hydatid cyst was laid open after