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Review Article

Presentation and management of hydatid cyst of the thigh: A systematic review of literature

Abdulwahid M. Salih1
,  
Fahmi H. Kakamad2,3  
,  
Shvan H. Mohammed3
,  
Hiwa O. Baba3
,  
Karukh K. Mohammed3
,  
Dlshad R. Ahmmad3
,  
Suhaib H. Kakamad3

1 Faculty of Medical Sciences, School of Medicine, Department Surgery, University of Sulaimani, François Mitterrand Street, Sulaimani,, Kurdistan Region, Iraq

2 Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq

3 Kscien Organization for Scientific Research, Sulaimani, Kurdistan, Iraq

Address correspondence to:

Fahmi H. Kakamad

Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan,

Iraq

Message to Corresponding Author


Article ID: 100957Z01AS2018

doi: 10.5348/100957Z01AS2018RA

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How to cite this article

Salih AM, Kakamad FH, Mohammed SH, Baba HO, Mohammed KK, Ahmmad DR, Kakamad SH. Presentation and management of hydatid cyst of the thigh: A systematic review of literature. Int J Case Rep Images 2018;9:100957Z01AS2018.

ABSTRACT

Hydatid cyst of the thigh is an extremely rare variant of the condition. The aim of this study is to systematically review the reported cases of hydatid cyst of the thigh. Science Direct, Web of Science, Medline on OVID, PubMed and Google scholar were scrutinized for articles which at least contain one new case of hydatid cyst of the thigh. Sixty-four patients were collected and discussed. In conclusion, hydatid cyst of the thigh is a very rare parasitic manifestation presenting as a painless swelling, diagnosed typically by magnetic resonance imaging and managed with en bloc resection.

Keywords: Hydatid cyst, Parasite, Thigh

INTRODUCTION

Echinococcus, a cestode of the Taeniidae family although lives outside the human body, causes a cystic parasitic infestation in mankind [1],[2]. The organism possesses both definitive and intermediate hosts. Wolves, dogs, and foxes (the definitive hosts) pass the worm’s eggs in their excretes into the surroundings, subsequently, the intermediate hosts (sheep, cattle, humans, horses, goats, and camel) develop hydatidosis [3]. The organs which are most incessantly affected by the disease are liver and lung, the latter is more common in the pediatric age group [4]. Other seldom affected organs are skeletal and smooth muscles, bone, viscera, and mediastinum [5]. Hydatid cysts (HCs) of the thigh is a very rare variant of the parasite manifestation, still, it occurs in endemic areas of the Middle East [6]. Presentation of the thigh HC, epidemiology, its clinical courses, diagnosis, and management are not well described. As there is no summary paper about thigh HC, this study was attempted to systematically review the reported cases of HC of the thigh worldwide.

METHODS

Search and information sources

Science direct, Web of Science, Medline on OVID, PubMed, Elsevier, Scopus, Wiley online and Google scholar were scrutinized for English-language articles distributed before 2018. The keywords were thigh hydatid cyst, thigh hydatidosis, hydatid cyst of the thigh, Echinococcosis of thigh. The data assemblage was enhanced by references from the included articles (Figure 1).

Eligibility criteria

For an article to be considered for this review, it had to include at least one new case of HC of the thigh. Exclusion criteria was articles without atleast one new case of HC of the thigh.

Data assemblage and review process

Data were excerpted from the included studies by two authors independently (second and fourth authors). Authors of the included articles have not been contacted to get and confirm the data. Several data were quoted and some of them were pooled including socio-demographic characteristics of the patients, sample size, presentations, duration of presentation, the method of diagnosis, options for management, recurrence rate and complications.

Summary measures and synthesis of results

Some data were calculated and re-analyzed. According to the variables, they were demonstrated as the percentage, mean values, and ranges of variation and percentages. Some other papers were illustrated and summarized in brief.

Figure 1: Flow chart of the included articles.

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RESULTS

The search through literature found 70 papers. From which 20 papers were excluded by titles. Other three papers were ostracized either because of scanty information or incomplete report. Two papers were omitted as a result of failure to be retrieved. The remaining 45 papers were analyzed and 64 patients were collected (Table 1). Thirty-seven of them (57.8%) were females, 27 (43.2%) were males. The age of the patients ranged from eight to 83 years with a mean age of 32.6 years. Almost all the patient presented with slow-growing mass. One of the patients presented with signs and symptoms of abscess (erythema, tender and swelling) [7]. The duration of the presentation was variable ranging from three days to 30 years with a mean period of the presentation was two years. The left side was affected more commonly than the right side (41/58, 70.6%). All patients received antihelminthics from the time of diagnosis (pre or postoperatively) until a variable length of time. All of the cases were managed by total resection. Three of the patients (4%) had HC other than thigh HC [8],[9],[10]. Two of them had retroperitoneal HCs another case had liver HC.

Table 1: Sociodemographic and clinical summary of the included articles

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DISCUSSION

The prevalence of thigh HCs is not notorious. Apart from two case series studies, all cases of thigh HCs accessible in the literature are case reports [11],[12]. Ammari and his colleagues published the registry of 13 years with nine cases of thigh HCs, seven patients were female, their mean age was 37 years [12]. Madhar et al presented seven cases of thigh HCs in a solitary paper from which six patients were female and their ages ranged from 19 to 56 years with a mean age of 30 years [11]. Thigh HCis either primary or secondary. In the latter, HCs should disturb concomitantly at least one of the common sites like liver, lung or spleen. Acu and his associates disclosed a case of thigh HC with concomitant HC of the left lobe of the liver occurring in a 20-year-female patient [8]. Sarda and his companions reported a 60-year-female with secondary HC of the thigh, the patient presented with swelling of the thigh with a palpable mass in the suprapubic region, during operation, they realized that there were two HCs. One of the thigh and other in the retroperitoneum communicating with each other via sub-facial plane [9]. In endemic countries, the disease might be prevented by several mechanisms including regular supplementation of praziquantel to the hosts, preventing dog’s access to intermediate hosts, vaccinating sheep, boiling or safe disposal of offal [13]. Up to date, 63 patients of thigh HCs have been reported in the medical literature [6],[7],[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50],[51],[52],[53] The age of the cases ranged from 8 to 83 years [4],[23].

The prevalence of thigh HCs is not notorious. Apart from two case series studies, all cases of thigh HCs accessible in the literature are case reports [11],[12]. Ammari and his colleagues published the registry of 13 years with nine cases of thigh HCs, seven patients were female, their mean age was 37 years [12]. Madhar et al presented seven cases of thigh HCs in a solitary paper from which six patients were female and their ages ranged from 19 to 56 years with a mean age of 30 years [11]. Thigh HCis either primary or secondary. In the latter, HCs should disturb concomitantly at least one of the common sites like liver, lung or spleen. Acu and his associates disclosed a case of thigh HC with concomitant HC of the left lobe of the liver occurring in a 20-year-female patient [8]. Sarda and his companions reported a 60-year-female with secondary HC of the thigh, the patient presented with swelling of the thigh with a palpable mass in the suprapubic region, during operation, they realized that there were two HCs. One of the thigh and other in the retroperitoneum communicating with each other via sub-facial plane [9]. In endemic countries, the disease might be prevented by several mechanisms including regular supplementation of praziquantel to the hosts, preventing dog’s access to intermediate hosts, vaccinating sheep, boiling or safe disposal of offal [13]. Up to date, 63 patients of thigh HCs have been reported in the medical literature [6],[7],[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50],[51],[52],[53] The age of the cases ranged from 8 to 83 years [4],[23].

CONCLUSION

Hydatid cyst of the thigh is a very rare parasitic manifestation presenting as a painless swelling, diagnosed typically by MRI and managed with en bloc resection.

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SUPPORTING INFORMATION

Author Contributions

Abdulwahid M. Salih - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Fahmi H. Kakamad - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Shvan H. Mohammed - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Hiwa O. Baba - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Karukh K. Mohammed - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Dlshad R. Ahmmad - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Suhaib H. Kakamad - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2018 Abdulwahid M. Salih et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


Comment on Article

Lumbar Spondylolysis
Malignant soft tissue tumor, wide excision, and sural flap
Knife swallowing ended up with esophagectomy