Hydatid cyst of the lumbar plexus: case report with review of literature

Abstract

Abstract Background Hydatid disease is widely distributed worldwide; it is caused by a parasite belonging to the Echinococcus species. It mostly affects the liver and the lungs, involvement of the spinal canal is reported to be around 0.2%, but affection of the peripheral nerves is extremely rare. Case presentation A 42-year-old lady was complaining from left loin pain and backache, with pain in the outer aspect of the left thigh for the last 5 years. During clinical examination, the ankle and the knee reflexes were normal and there was no muscle wasting. There was hyperesthesia on the outer aspect of the left leg. Magnetic resonance imaging of the back demonstrated a cystic lesion between the 4th and the 5th lumbar vertebrae which was pushing the psoas muscle anteriorly and causing atrophy of the muscle. The patient received anthelminthic medications for 1 month before surgery with little improvement of the clinical and the radiological condition. During surgery the cyst was found to arise from the lumbar nerve sheath and was apparent to be hydatid cyst because it was containing small daughter cysts. Isolation of the cyst was done and complete evacuation with deroofing of the cyst was done. The cavity of the cyst was irrigated with a solution of chlorhexidine as a scolicidal agent. The patient was discharged home after 3 days with no post-operative complications, anthelminthic medications prescribed for 3 months. Conclusion The treatment options vary depending on the region affected by the cyst; it may be treated by complete cyst excision, evacuation, and deroofing. Preventing spillage of the contents of the cyst during surgery and the use of scolicidal agents are mandatory to decrease the rate of recurrence. It is very important to exclude other organ involvement particularly pulmonary involvement before surgery.