Dilemmas encountered while dealing a pregnancy complicated by pelvic Hydatid disease

Splenic hydatid disease in pregnancy

“… 6 Of note, albendazole was used in conjunction with the PAIR approach in order to reduce cyst size and decrease subsequent risk of an anaphylactic reaction and recurrence. 6 , 7 The use of pharmacological therapy as a primary treatment modality in splenic hydatid disease is discouraged. 6 …”

“… 7 This is thought to be due to the decrease in cell-mediated immunity in the gravid state. 7 Peritoneal recurrence can even present 4–15 years after splenectomy. 15…”

“…6 Of note, albendazole was used in conjunction with the PAIR approach in order to reduce cyst size and decrease subsequent risk of an anaphylactic reaction and recurrence. 6,7 The use of pharmacological therapy as a primary treatment modality in splenic hydatid disease is discouraged. 6 Total splenectomy is preferred when more than 75% of the spleen is involved, when multiple cysts occur or when there are centrally located cysts.…”

“…9 Due to the limited data available in managing splenic hydatid disease in pregnancy, experts suggest a case-by-case assessment. 7,9 Albendazole should be avoided in the first trimester due to potential teratogenic effects and all invasive therapeutic interventions that are deemed necessary should ideally be performed at 20-24 weeks gestation. 10 Antihelminthic drugs are considered safe in the latter stages of pregnancy; however, in the published studies where albendazole had been used in obstetric patients, the reported doses used were far lower than those required in hydatid disease.…”

“…13 Hydatid disease has a post-surgical recurrence rate of about 10%; however, this risk is increased when the surgical procedure is performed in pregnancy. 7 This is thought to be due to the decrease in cell-mediated immunity in the gravid state. 7 Peritoneal recurrence can even present 4-15 years after splenectomy.…”