|Beitragstitel||Internal hemipelvectomy and partial sacrum resection in a patient with pelvic bone hydatidosis. A case report.|
Most hydatid cysts occur in the liver or in the lung. Hydatidosis of bone is rare and accounts for only 0.5 to 4% of all locations. The only curative treatment is surgery. We report a case of hydatid disease involving the entire left pelvis, hip joint and left sacrum.
A 29 years old male patient presented with limping and left hip pain. The medical history revealed the diagnosis of a tumour-like mass of the left supraacetabular region 3 years before. Open biopsy at that time confirmed a localized cystic echinococcus infection. Two surgical interventions with supraacetabular tumour excision and following anthelmintic therapy were performed. Despite progressive load related pain, further examinations in the country of origin were reported as normal.
At first presentation at our institution, plain radiography revealed extensive osteolytic lesions at the left iliac bone and acetabulum together with degenerative changes of the hip joint. CT and MRI showed severe bone destruction of the whole left hemipelvis extending to the sacroiliac joint with involvement of the neuroforamina S1 and S2 and the surrounding intra- and extrapelvic soft tissues. After positive serological testing and initiation of an antihelmintic therapy an internal left hemipelvectomy together with a partial transforaminal sacrum resection was performed. Additional proximal femur resection was necessary due to hip joint involvement. During surgery, the adjacent tissue was protected with 20% NaCl solution. Due to extensive bone loss and the remaining unprotected nerves of the lower limb after surgery, second stage prosthetic procedure was deemed impossible. The remaining pelvitrochanteric muscles were fixed to the abdominal wall in a mitre-like fashion allowing limb control.
The patient showed pain free and fluent ambulation using two crutches in the postoperative course. MRI examination 6 months postoperatively showed no evidence of local recurrence.
Hydatide osteopathy is an infiltrating, progressive disease. Surgery in combination with pre- and postoperative antihelmintic therapy is the only curative treatment. Early diagnosis helps in the eradication and salvage of the bone. The treatment remains challenging with the potential of functional loss and local recurrence rates reported up to 17%.