Unusual location of primary hydatid cyst: soft tissue mass in the supraclavicular region of the neck.

Cystic hydatid disease is a zoonosis caused by Echinococcus granulosus. It may affect any organ and tissue in the body, in particular the liver and Lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0,5%-5% of all echinococcal infections in endemic areas and is almost secondary to the hepatic or pulmonary disease (Karaman et al., 2011; Dirican et al., 2008; Kouskos et al., 2007). Case Presentation. We report an unusual case of primary subcutaneous hydatidosis in the left supraclavicular region of the neck. A 53-year-old female patient was admitted with three-month history of pain and gradually growing mass located in the left supraclavicular region. Physical examination revealed a moderately hard, painful, and erythematous mass. The blood cell count was normal. Computed tomography demonstrated, a multilocular cystic lesion with thin borders and thin wall. The mass is binocular and extends to the scapula. CT showed no involvement of the lung. From these signs, the patient was diagnosed as having abscess (bacterial infection or tuberculosis). The diagnosis of Echinococcus granulosus infection was made per operatively after visualization of the cyst wall and the daughter cysts. Following irrigation of cystic cavity with hypertonic saline solution, the cyst wall was excised along with a portion of surrounding tissue. Histopathological examination of the specimen confirmed the hydatid origin. Hemagglutination tests for Echinococcus and ELISA were negative. Ultrasound of the abdomen was normal. The patient received albendazole (400 mg/day) for 8 weeks postoperatively. No sign of recurrence could be detected by physical examination and imaging (CT) at 4-month followup. Conclusion. The case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when it occurs in endemic areas.

[The lithiasic acute cholecystitis: laparoscopic treatment (About 106 cases)]. / La cholécystite aigue lithiasique: traitment laparoscopique (a propos de 106 cas).

AIM: To assess the feasibility and the advantages of the coelioscopy in the treatment of the acute cholecystitis. METHODS: From January 1996 to December 2001, 106 laparoscopic cholecystectomies for acute cholecystitis have been collected. The diagnosis of acute cholecystitis has been confirmed for all cases by the pathologic exam. RESULTS: These 106 cases represent 12.4% of the set of the laparoscopic cholecystectomies practiced during the same period of survey. They are 78 women and 28 men. The mean age was 51.7 years. Eight patients (7.6%) presented an elevated operative risk (ASA III). The diagnosis of acute cholecystitis has been kept before operation in 45.3% of the cases. Major or minor intraoperative incidents have been observed in 18.9% of the cases. The rate of conversion was 17%. The reasons are dominated by the difficulties of dissection in 10 cases (55.5%) and hemorragea in 6 cases. The research of the predictive factors of conversion found 5 factors, the hyperleucocytosis, the operative delay superior to 72 hours, the adhesions around the gallbladder, the gangrenous gallbladder and the pediculitis. The post operative mortality was nul. The morbidity rate was 12.3%. Among the 13 patients who had postoperative complications, 8 were after conversion. CONCLUSION: These results showed that the laparoscopic cholecystectomy for acute cholecystitis is an effective and good alternative with acceptable morbidity that should decrease with learning curve.