Abdominal examination revealed a tender firm mass in the right iliac fossa, measuring 5 cm × 3 cm, with restricted mobility. Muscle Quizartinib ic50 guarding was present over the lump. Straight leg rising, cough sign and rebound tenderness were positive. Further investigations were conducted to address clinical suspicion of appendicular mass. Laboratory investigations revealed a haemoglobin level of 9.2 g/dL, neutrophilic leucocytosis (16,000/mm3) and marked eosinophilia (19%). Ultrasonography (USG) abdomen revealed a multiseptated cyst (5.2

cm × 2.5 cm) with honeycomb appearance in the right iliac fossa, suggestive of HD (Figure 1). Rest of the abdomen did not reveal any other hydatid cyst. ELISA (enzyme-linked immunosorbent assay using purified Echinococcus antigen, positive with a titre of more than 1:128.) for hydatid was positive. Figure 1 USG showing Hydatid cyst in the right iliac fossa. At laparotomy the cyst was found to be located in the appendicular mesentry. Excision and appendectomy was performed. Other areas of the abdomen did not reveal any cysts. Recovery was uneventful and patient was discharged with Albendazole (800 mg/day) for one month. The patient is doing well after one year follow-up. Repeat abdominal USG after one year follow-up

was within normal limits. Discussion Intraperitoneal hydatid cysts usually develop secondary to spontaneous or iatrogenic rupture of hepatic, splenic, or mesenteric cysts. Rarely isolated primary cyst may develop in the peritoneum without evidence of cysts in other intra abdominal organs. Primary peritoneal echinococcosis accounts

for 2% of all abdominal hydatidosis. [2] IBET762 Dissemination occurs either by lymphatic [3] or systemic [4] circulation. Clinical manifestations are due to mass effect of enlarging abdominal cyst. Diagnosis is confirmed by radio-imaging studies (abdominal sonography and computerized tomography) complimented with serological tests (Complement fixation test, Indirect hemagglutination test and ELISA). [5, 6] Primary peritoneal hydatid cyst masquerading as ovarian, mesenteric, duplication and other intra-abdominal cysts have been reported. All these patients had evidence of hydatosis in other peritoneal organs. [1–8] A single primary peritoneal hydatid cyst without any hepatic Ureohydrolase or extrahepatic organ involvement mimicking appendicular lump has been unheard of as yet. Surgery is the treatment of choice for primary abdominal HD. [7, 8] Pre operative courses of Albendazole should be considered in order to sterilize the cyst, decrease the chance of anaphylaxis, decrease the tension in the cyst wall (thus reducing the risk of spillage during surgery) and to reduce the recurrence rate post-operatively. [7, 8] Intra-operatively, the use of hypertonic saline or 0.5% silver nitrate solutions before opening the cavities tends to kill the daughter cysts and therefore prevent further spread or anaphylactic reaction.