Management of vulvar lymphedema of filarial origin in a pregnant woman and its outcome: A case report.

Lymphedema of filarial origin affecting the vulva is extremely rare. It is a dilemma if seen in a pregnant woman as there are no guidelines regarding excision and the mode of delivery. With the World Health Organization-driven global program to eradicate filaria, it is unfortunate to see such cases. We report of a woman who had massive lymphedema of both the labia majora following filarial infection with a small secondary ulcer. She presented to our outpatient department in early pregnancy. After detailed counseling with the couple, a decision was taken for excision. The same was carried out. The wound healed well but the lymphedema recurred after 6 weeks. She was thereafter managed symptomatically. Pregnancy advanced without any complication. Her intrapartum management for a successful vaginal delivery is outlined in the report.

Major liver resection in pregnancy: three cases with different etiologies and review of the literature.

BACKGROUND: Major liver resection during pregnancy is extremely rare. When required, the associated physiologic and anatomic changes pose specific challenges and greater risk for both mother and fetus Materials and methods: Three cases of major liver resection during pregnancy due to different etiologies are presented. The relevant literature is reviewed and discussed. RESULTS: We present three cases of major liver resection due to giant liver hemangioma with Kasabach-Merrit syndrome, giant hydatid cyst, and intrahepatic cholangiocarcinoma, at gestational week (GW) 17, 19, and 30, respectively. All patients had an uneventful postoperative course, continued the pregnancy and gave birth at GW 38. CONCLUSION: Major liver resection can be performed safely during pregnancy. A multidisciplinary team of surgeons, anesthesiologists and gynecologists, in a highly experienced tertiary hepatobiliary center, should be involved.

Long-term results of percutaneously treated multiple hepatic and splenic hydatid cysts in a pregnant woman.

Hydatid disease is caused by Echinococcus granulosus, which is endemic worldwide. This parasitic tapeworm can produce cysts in almost every organ of the body; however, the liver and lungs are the most frequently targeted. 37­year-old multigravida woman with a 10-week pregnancy in whom multiple splenic and liver hydatid cysts were detected by ultrasound. All splenic and liver hydatid cysts were treated percutaneously under US guidance during the 14th week of pregnancy. The catheterization method was used in the treatment of all hydatid cysts. Alcohol was also used as scolicidal and sclerosing agent in all procedures. There were no major complications. A cystobiliary fistula developed in a hydatid cyst treated in the liver. A healthy baby was delivered vaginally at term.

Enterobius vermicularis salpingitis seen in the setting of ectopic pregnancy in a Malaysian patient.

We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing.

Hepatic hydatid disease requiring urgent treatment during pregnancy.

BACKGROUND: Pregnant women may experience an acute presentation of hepatic hydatid disease. The available literature is limited to case reports. METHODS: The charts of 7 patients who underwent urgent treatment for hepatic hydatid disease during pregnancy between 1992 and 2010 were reviewed. RESULTS: The median patient age was 27 (range 23-39) years and median gestational age was 18 (range 13-24) weeks. The symptoms were severe abdominal pain (4), vomiting (2), jaundice (2), pruritus (2) and severe dyspepsia (1); in the asymptomatic patient, a closed intraperitoneal rupture had been detected during gynecologic ultrasonography. Surgical drainage of the cysts was performed in all cases. The two patients with frank biliary rupture underwent choledochoduodenostomy or Roux-Y hepaticojejunostomy. Four patients required postoperative tocolysis. Albendazole was not used. All mothers gave birth to healthy babies at term. The patients were followed for a median of 9 (range 4-19) years. Two patients developed recurrences at 2 and 7 years; these were treated with surgical drainage and albendazole. CONCLUSION: This entity entails the responsibility of two human beings. Although it imposes limitations on the routine diagnostic and therapeutic options due to risk of premature labor or teratogenicity, acceptable results can be obtained in collaboration with the department of obstetrics and gynecology.

Human hydatidosis in Tehran, Iran: a retrospective epidemiological study of surgical cases between 1999 and 2009 at two university medical centers.

This study was conducted to evaluate retrospectively 203 patients diagnosed with hydatid cyst disease and treated surgically at two university medical centers between 1999 and 2009 in Tehran, the capital of Iran. Cystic echinococcosis (CE) affected more females 117 (57.6%) than males 86 (42.4%). A remarkable gender difference skewed towards females was observed, and the male/female ratio among CE cases ≤20 and ≥61 years old was 1.18 and 0.52, respectively. The age of the patients ranged from 8 to 82 years, and the age group 21-40 years (42.8%) was the most affected. A significantly higher number of hydatid cysts were recorded in the liver than in other sites (P<0.001), and more females had higher hepatic cysts (48.8%) than males (35.0%). The ratio of hepatic hydatidosis to pulmonary hydatidosis was about 11. There was a relative direct relationship between the ratio of liver to lung cases and age, and this ratio was significantly (P<0.01) higher in individuals >40 years of age (liver/lung ratio ≥43) than in those <40 years of age (liver/lung ratio 2.8-7.6). Unusual cyst locations in kidneys, brain and pelvic area, followed by spleen and spine was also observed. Single organ involvement was found in 95% of the patients, and was more common in females (55.2%) than in males (39.9%). Housewives had the highest rate of infection (53.5%) followed by labourers with 14.8%, which showed a significant difference (P<0.001). Similarly, urban dwellers was also over-represented among the cases (87% urban vs. 13% rural; P<0.001). In 69.5% of cases there was only one cyst, 16.3% had two cysts, 4.7% with three cysts, and 9.5% had four cysts or more. The results showed that further studies are needed to determine the prevalence, economic impact and risk factors of the disease in the area.

Abdominal and pelvic hydatid cyst obstructing the labor.

Hydatid cystic disease is a parasitic disease primarily infesting the sheep and cattle. It is a rare condition in pregnancy with an incidence of 1/20000 pregnancies. An eighteen-year-old primigravida was evaluated due to obstructed labor. Multiple abdominal and pelvic hydatid cysts were diagnosed by ultasonography and a healthy infant with birthweight of 3330 g was delivered by cesarean section. While the cysts situated on the posterior uterine wall, paraovarian region and omentum were removed totally, the hepatic cysts were only partially removed and then drained. The hydatid disease should be considered in differential diagnosis of adnexal masses obstructing the labor in pregnancy (Fig. 3, Ref. 9).

Hydatid cyst of urinary bladder associated with pregnancy:a case report.

Echinococcosis or hydatid disease which is caused by Echinococcus group of cestodes is very rare in pregnancy. While liver and lungs are commonly involved, other sites can be rarely affected. The management of hydatid disease in pregnancy is challenging in view of varied presentation and manifestation. We report a case of hydatid cyst arising from the bladder associated with pregnancy and presenting with abdominal pain. The cyst was surgically removed and the bladder wash was given with povidone-iodine. The postoperative recovery was uneventful with ongoing pregnancy. This is to our knowledge, the first case of hydatid cyst arising from the bladder associated with pregnancy to be reported.

Enterobius vermicularis infection with tuboovarian abscess and peritonitis occurring during pregnancy.

BACKGROUND: Extraintestinal Enterobius vermicularis infections are rare but may occasionally affect the female genital tract. Although mostly asymptomatic or causing minor clinical problems, they may lead to severe infectious complications. METHODS: Case report and review of the pertinent English language literature. RESULTS: A 31-year-old, 30-week-pregnant female was admitted with a clinical suspicion of appendicitis. At surgery, the appendix appeared normal, but generalized peritonitis of unclear origin was present. Eggs of Enterobius vermicularis were found upon microbiological and pathological examination. Because of persisting infectious disease, the patient underwent an elective caesarean section, and at that time the diagnosis of a right tuboovarian abscess was made, and salpingo-oophorectomy was performed. The pathology report confirmed the diagnosis of an E. vermicularis salpingo-oophoritis. CONCLUSION: This case was extraordinary because of a combination of tuboovarian abscess and generalized peritonitis with E. vermicularis infection occurring during late pregnancy. Ectopic enterobiasis should be considered in the differential diagnosis of pelvic infections of gynecological origin.

Management of hydatid disease (echinococcosis) in pregnancy.

Hydatid disease, manifesting as single or multiple hydatid cysts and caused by Echinococcus granulosus, is common in many parts of the world, especially the tropical countries. Although rare, this disease can also present during pregnancy, especially in endemic areas. Although much has been written about hepatic hydatidosis, there are only a few articles (mainly case reports) on hydatid disease in association with pregnancy. A literature search was done through Medline/PubMed and Medscape independently by the authors from 1950 to 2007 for key words "echinococcosis" and "pregnancy" and "management." All retrieved articles were reviewed. Manual cross-referencing was also done with inclusion of all relevant articles. In this review, we have attempted to summarize the presentation and available management approaches to hydatid disease, and have suggested evidence-based guidelines for its management during pregnancy.

Recurrent hepatic hydatid cyst in a pregnant woman.

BACKGROUND: Hydatid cyst in pregnancy is a very rare pathology and its diagnosis and treatment is still a complex problem. This report describes the clinical features and evolution of a pregnant woman operated for a recurrent hepatic hydatid cyst. CASE REPORT: A 26-year-old multigravida was admitted to our hospital in her 16th week of pregnancy because of dyspeptic complaints. She had had previous operations for hydatid cyst. A 7x5x6 cm recurrent hepatic hydatid cyst and cholelithiasis were diagnosed on sonographic evaluation. Partial cystectomy, external drainage, and cholecystectomy were performed in the second trimester of her pregnancy. No complication occurred and she gave birth to a healthy baby five months later. CONCLUSIONS: Every physician working in endemic areas should be aware of this potential healthy problems because a hydatid cyst can cause severe complications and be fatal to both mother and baby.

[Hydatic cysts--echinococcosis]. / Echinokoková nákaza--echinococcosis.

The case diagnosis and treatment of hydatic cyst in the right and left lobe of the liver in a 28 year old pregnant woman is described in the article.

Abdominal and pelvic hydatid disease during pregnancy.

BACKGROUND: Hydatid disease is an infection of sheep and cattle. Affected human beings are only chance intermediate hosts. It is a rare condition in pregnancy. CASE REPORT: We present a 15-week pregnant patient with cysts in the liver and in the right adnexa identified by ultrasonography and magnetic resonance imaging. Diagnosis of hydatid disease was confirmed by an indirect hemagglutination test. OUTCOME: The patient underwent laparotomy and a healthy baby was delivered at term.