Leos-Acosta CA, Morales-Montor JG, Camarena-Reynoso HR, Shuck-Bello CE, Cantellano-Orozco M, Hernández-Castellanos VA, Fernandez-Noyola G, Pacheco-Gahbler C, Calderón-Ferro F

Language: Spanish
References: 10
Page: 384-388
PDF size: 867.26 Kb.

ABSTRACT

The patient is a seventy-six-year-old woman whose disease began five months prior to hospital admittance where she presented with diffuse, predominantly epigastric abdominal pain accompanied with nausea and occasional vomiting, sporadic headache, and generalized jaundice. Endoscopic retrograde cholangiopancreatography was carried out as general surgery procedure for symptoms of choledocolithiasis. Study protocol included abdominal computed tomography that revealed a 59 x 49 mm incidental tumor dependent on left adrenal gland with attenuation value of thirty-six to seventy-six Hounsfield units. Physical examination revealed no alterations. Serum electrolytes and metanephrines in urine and plasma were normal.
Diagnosis was solid adrenal tumor and patient was programmed for left laparoscopic adrenalectomy which was carried out with no complications. Histopathological report was 6.5 x 6 x 5 cm adrenal hydatid cyst.
Patient presented with adequate immediate postoperative progression and tolerated oral food intake two days after surgery. There was no evidence of complications. Patient was released from hospital for out-patient management with good blood pressure control and was completely asymptomatic at fourmonth postoperative follow-up.
Discussion: Echinococcosis frequency varies according to geographic location. Italy is the country considered to be at highest risk, presenting up to one thousand cases per year that require surgery. The most frequent sites are the liver (45-75%) and lung (10-50%). The heart, spleen, kidney, and brain make up approximately ten per cent of the remaining cases and adrenal hydatid cyst corresponds to at least one per cent of all cases.
Laparoscopic adrenalectomy offers better gland visualization and eliminates the need for laparotomy. In addition it allows for complete exploration of the peritoneal cavity. Transabdominal laparoscopic adrenalectomy was carried out in this case report. The benefits of this technique in regard to open technique are well-known and include smaller surgical wound, shorter surgery duration, and shorter hospital stay.

REFERENCES

1. Kern P, Bardonnet K, Renner E, et al. European echinococcosis registry: human alveolar echinococcosis, Europe, 1982–2000. Emerg Infect Dis 2003;9:343-9.

2. Akcay MN, Akcay G, Balik AA, Boyuk A. Hydatid cysts of theadrenal gland: review of nine patients. World J Surg 2004;28:97-9.

3. Bastounis E, Pikoulis E, Leppaniemi A, Cyrochristos D. Hydatid disease: a rare cause of adrenal cyst. Am Surg 1996;62:383-5.

4. Escudero MD, Sabater L, Calvete J, et al. Arterial hypertension due to primary adrenal hydatid cyst. Surgery 2002;132:894-5.

5. Bedioui H, Jouini M, Nouira K, et al. Primary hydatid cyst of adrenal gland. Report of two cases. Ann Chir 2005;130:104-7.

6. Defechereux T, Sauvant J, Gramatica L, et al. Laparoscopic resection of an adrenal hydatid cyst. Eur J Surg 2000;166:900-2.

7. Vuitton DA. The WHO Informal Working Group on Echinococcosis. Coordinating Board of the WHO-IWGE. Parassitologia 1997;39:349-53.

8. de Bree E, Schoretsanitis G, Melissas J, et al. Cysts of the adrenal gland: diagnosis and management. Int Urol Nephrol 1998;30:369-76.

9. WHO Informal Working Group: International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003;85:253-61.

10. Marani SA, Canossi GC, Nicoli FA, et al. Hydatid disease: MR imaging study. Radiology 1990;175:701-6.