Enucléation d’un kyste hydatique du muscle psoas chez un enfant

Hydatid cyst of the psoas muscle is exceptional and manifests itself as a non-specific mass syndrome. Pain or compressive symptoms lead patients to go to their doctor. This cyst is characterized by an insidious development, which explains why they can grow large. Abdominal ultrasound is the gold standard test. CT scan is better in detecting the relations between this cyst and its neighboring structures. Surgery is the therapeutic method of choice. Extraperitoneal approach helps prevent intra-abdominal contamination. Perikystectomy should be performed or, even better, enucleation. Puncture, evacuation and sterilization of the cyst are even more effective because the cyst develops in the full thickness of the psoas muscle. Too large an excision may compromise functional outcome. Prognosis is generally good. We here report the case of a 5-year old girl of rural origin presenting with a 3-month history of painful mass in the right iliac fossa characterized by a progressive and insidious development. Ultrasound showed anechogenic cystic lesion in the right iliac fossa measuring 55*38 mm, suggesting hydatid cyst (A). Scan (B) confirmed the diagnosis of hydatid cyst of the iliopsoas muscle (measuring 52*42*55 mm) associated with thinned iliac bone. Extra-peritoneal oblique mini-laparotomy was performed. Then, enucleation of the cyst without rupture was performed (C and D). Clinical and ultrasonographic follow-up was satisfactory.