Parametrial hydatid cyst with cystovesical fistula: a rare presentation

Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Theoretically, echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. However, uterus and and adnexa have an incidence of 0.5-1%. Till date, three cases have been reported in which a parametrial hydatid cyst formed a bladder fistula. A 57 year old female was admitted with complaint of burning micturition along with white coloured urine for the last 15-20 days with no other significant history. On examination and evaluation, it was suspected to a neoplastic pelvic mass causing gross right sided hydronephrosis. All biochemical markers were within normal limits. The patient was explored surgically on which a thick-walled lesion was found in right parametrium. The cavity of the lesion was filled with daughter hydatid cyst, along with communication into the bladder via a fistula. Open cystectomy was done after evacuation of daughter cysts and irrigation with scolicidal agents. The fistula was repaired. The patient recovered uneventfully and was doing well on follow-up. The incidence of hydatid cysts in the female reproductive system is very low and constitutes less than 0.5% of all hydatid cysts. However, rare cases have been reported, thus the clinician must be aware of this rare disease and should take precautions while operating, as any spillage may lead to anaphylactic shock.

Foramen congénito del ligamento ancho con hernia enteral interna y sufrimiento intestinal reversible: presentación de dos casos / Two cases of congenital foramina in the broad ligament of the uterus with small bowel hernias and reversible intestinal distress

Se trata de dos pacientes con un foramen congénito del ligamento ancho que permitió el paso de un asa de intestino delgado y posteriormente causó un cuadro de obstrucción intestinal completa con sufrimiento de asa reversible. Se descartaron antecedentes quirúrgicos, traumáticos e infecciosos que pudieran simular un anillo intraperitoneal congénito.

We report two cases of congenital foramina in the broad ligament through which segments of the small intestine passed producing intestinal obstruction with reversible bowel distress. Surgical, traumatic and infectious causes that could simulate congenital intraperitoneal bands were ruled out.

The Role of Computed Tomography (CT) Scan in Assessment of the Parametrial Involvement in Early Stage Cervical Carcinoma

This retrospective study is aimed at evaluating the role of CT scan in predicting parametrium involvement in early stage of cervical carcinoma. It was conducted in a Gynaecologic Oncology Centre, Hospital Alor Star from January 2004 till December 2008. All patients with operable stage I and II cervical cancer had pelvic CT scan for evaluation of parametrium involvement before undergoing radical hysterectomy and pelvic lymphadenectomy. Parametrial streakiness or presence of infiltration suggested local invasion. Following radical hysterectomy, the specimens sent for histological confirmation and the correlation between the CT scan finding and the histopathology result was studied. The result revealed a total of 104 patients with operable stage cervical carcinoma had pelvic CT scan. The sensitivity and the specificity of CT scan in assessing parametrial involvement was 33.3% and 84.8%, respectively. In conclusion, CT scan had high specificity but low sensitivity in determining parametrial involvement in early stage of cervical cancer. Hence, routine preoperative pelvic CT scan has a limited role in assessing parametrial involvement in early stage cervical carcinoma.