ABSTRACT
Introduction: Hydatid disease is a parasitic disease caused by Echinococcus species, and is a serious sometimes fatal, that is endemic in many parts of the world, especially in South America, the Middle East including Yemen, Australia, and the mediteranean region. Hydatid disease of the skeletal muscle is rare. Presentation of Case: This article presents an unusual three Yemeni cases of subcutaneous and intramuscular hydatid cyst of the thigh. The ages of one male and two women are 32, 38 and 27 years respectively. They admit to IBN Sina hospital complain of dull aching pain, but no fever or other symptoms indicating infection or metastatic neoplastic soft tissue mass, lipoma or cystic swelling for differential diagnosis. Clinical manifes-tation was nonspecific and the diagnosis mainly depends on radiological evaluation which included mainly CT, MRI and laboratory investigation which is mainly ELISA test for Echinococcus granulosus Ab. After the patient admitted to the hospital, preoperative albenazole for ten days to treat patient, and surgical excision procedure pericystectomy were performed for the cyst combined with postoperative albendazole. In our 3 cases, this surgical approach was performed to extract the hydatic cyst completely intact without rupture and was achieved in 2 cases, while rupture occur in one case (case No. 3). The cyst was ruptured during intramuscular dissection. In spite of that, she passed well without intra or post-operative early or late complications. Use of intra-operative hypertonic 10% saline solution is mandatory to prevent the dissemination of protoscoleces. Chemotherapy enabled the authors to treat the patient with preoperative albenazole for ten days and to prevent postoperative recurrence of the disease. Discussion: The diagnosis of echinococcosis should be considered when soft tissue mass grows slowly for months or years, in any patient from the endemic area. Patients presented with this rare hydatic cyst diseses in subcutaneous and intramuscular space of the thigh, whom were found in our country (Yemen) were successfully treated with pericystectomy. Preoperative intake of albenazole is very important to minimize intra-cystic pressure, increase the incidence of intra-operative rupture of the cyst during manipulation and to prevent post operative parasitic dissemination. Conclusion: Surgical pericystectomy combined with albendazole is known to be curative for soft tissue hydatic cyst. Rare cases like this must be truly diagnosis and treated to prevent severe complication of this disease.