Pelvic hydatid disease
Filariasis
Infection with Wuchereria bancrofti, Brugia malayi, B. timori, and Loa loa affects not only the lymphatics but also such structures as the kidneys; renal damage can occur even in asymptomatic carriers. Ultrasonography detects live adult filarial worms by identifying twirling motions in dilated lymph channels; successful chemotherapy ends the worm activity. Lymphoscintigraphy is of value in assessing lymphatic damage. Extensive lymphoscintigraphic abnormalities are found in W. bancrofti-endemic regions even in clinically asymptomatic persons. Chyluria is common. Among patients with filarial chyluria undergoing unilateral pedal lymphography, lymphatic crossover was identified in all and lymphaticorenal fistulas were detected in 98%; the authors advocate unilateral lymphography over a bilateral study because lymphatic crossover identifies lymphaticorenal fistulas regardless of the side of involvement. Echinococcosis A primary echinococcal cyst in the peritoneum is rare. A study from Tunis found that retrovesical and extraperitoneal sites represent about 10% of their operated hydatid cysts; a retrovesical site presumably represents secondary implantation in the pouch of Douglas by intraperitoneal rupture of a more conventionally located cyst.
Infection with Wuchereria bancrofti, Brugia malayi, B. timori, and Loa loa affects not only the lymphatics but also such structures as the kidneys; renal damage can occur even in asymptomatic carriers. Ultrasonography detects live adult filarial worms by identifying twirling motions in dilated lymph channels; successful chemotherapy ends the worm activity. Lymphoscintigraphy is of value in assessing lymphatic damage. Extensive lymphoscintigraphic abnormalities are found in W. bancrofti-endemic regions even in clinically asymptomatic persons. Chyluria is common. Among patients with filarial chyluria undergoing unilateral pedal lymphography, lymphatic crossover was identified in all and lymphaticorenal fistulas were detected in 98%; the authors advocate unilateral lymphography over a bilateral study because lymphatic crossover identifies lymphaticorenal fistulas regardless of the side of involvement. Echinococcosis A primary echinococcal cyst in the peritoneum is rare. A study from Tunis found that retrovesical and extraperitoneal sites represent about 10% of their operated hydatid cysts; a retrovesical site presumably represents secondary implantation in the pouch of Douglas by intraperitoneal rupture of a more conventionally located cyst.
This is radiology images of the pelvic hydatid disease. A,B: Two contrast-enhanced CT images through the pelvis shows daughter cysts within a denser structure adjacent to the left iliac muscle.Detached membranes are evident in the cyst shown in part B
Parasitic Infestation Parasitic infestations involve myriad end organs, with the peritoneal cavity often serving as an intermediary pathway. Peripheral eosinophilia often suggests underlying parasitic infestation, although it is present only in about half of infected patients, and generally during the acute phase.Acute or vague abdominal pain is common. Serologic tests (enzyme-linked immunoabsorbent assay) are available for some infestations. Computed tomography detects focal omental, peritoneal, mesenteric, or bowel wall infiltration, often heterogeneous and partly cystic in nature. The imaging differential diagnosis often includes other inflammatory conditions and neoplasms.
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