Mass in the Left Iliac Fossa-a Diagnostic Dilemma

Clinical diagnosis of abdominal masses remains a challenge to this day; in spite of the availability of advanced imaging facilities, we fail to reach a definitive diagnosis in a few cases and have to resort to a laparotomy, which reveals unexpected findings. We present a case of a 70-year-old lady who presented with pain abdomen and loss of appetite for 3 months; clinical examination revealed a fixed intra-abdominal firm to hard mass in the left iliac fossa. CT scan of the abdomen showed a large cystic hypodense lesion in the left iliac, lumbar and hypogastric region with no definite organ of origin. The patient underwent an exploratory laparotomy and in toto excision of the cyst; on opening the cyst wall, we found multiple daughter cysts in a pool of thick, purulent fluid. Microscopic examination confirmed the presence of a hydatid cyst Primary peritoneal hydatid cysts are a rare entity and constitute around 2 % of hydatid cysts found in the human body. Very few cases of primary peritoneal hydatid cyst have been reported from non-endemic areas, and this case report highlights the need to maintain a high index of suspicion while evaluating cystic abdominal swellings.