A 76-year-old male, farmer, with a history of hypertension, chronic obstructive pulmonary disease, atrial fibrillation and stroke two years ago, who consulted the emergency department for presenting a painful right inguinal tumor for three days.
He did not report other accompanying clinical manifestations.
On physical examination the patient has good general condition with adequate coloration and hydration.
The exploration of the respiratory and cardiological apparatuses is normal and in the abdomen a tumor in the right inguinal region is seen, hard, painful and irreducible to palpation.
Laboratory data show 10,600 leukocytes without left shift and 6% eosinophils.
A plain chest and abdominal x-ray (which does not include the whole pelvis) showed no abnormalities.
With the presumptive diagnosis of complicated right inguinal hernia, the patient is operated finding during surgery a cystic tumor 4 cm in diameter that accidentally contains upper branch of the pubis that ruptures gallbladder.
Partial cystectomy and lavage with hypertonic serum were performed.
The pathological study showed the cyst wall with fibrosis relapsed in its internal part by histiocytes and abundant multinucleated giant cells and inside it cellular debris, hyalgantic membranes acellularized.
The postoperative course was uneventful. During the postoperative period, a serologic study was performed with indirect hemagglutination. The patient showed ruptured titers of 1/160, an adjacent radiograph of the pelvis showing an expansive cortical branch.
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At discharge, the patient is asymptomatic and oral treatment with albendazole 800 mg/day is initiated, administering 28-day cycles of treatment followed by 14 days of rest until completing 3 cycles.
In subsequent controls, the patient has a painful limitation to hip mobilization in its maximum axes, which does not prevent him from performing an autonomous life and controls with analgesics.
Pelvic X-ray shows multiple cystic lesions, but the distinctive feature does not respect the cortical bone in the pubic ilio ischial branches of the right hemipelvis and the space in which the preservative does not exist.
Conservative treatment and regular follow-up in consultation were chosen.
Ten months after diagnosis, the patient presents a progressive deterioration of his cognitive abilities and his relationship with the environment, and after suffering a fall, he is admitted to the hospital with pain and impotence to ambulation.
Pelvic radiography showed a fracture of pelvic branches with joint involvement in the right hemipelvis on the affected area of hydatidosis, without displacement of fragments.
A joint replacement with a total prosthesis with an active infection would be contraindicated due to the risk of dissemination of the parasitosis and en bloc resection of the lesion and implant of a prosthesis as long as the acetabulum is reconstructed.
