Spontaneous Drainage of an Asymptomatic Recurrent Hydatid Cyst of the Sacrum

Study Design. A case report. Objective. This is an unusual presentation of recurrent hydatid disease. Spillage of a hydatid cyst was previously reported in a symptomatic case of primary spinal hydatid disease. However, we did not find any examples of spontaneous discharge of hydatid cyst fluid in an asymptomatic case in the literature. Summary of Background Data. Bone hydatid cysts occur in 1% to 2.5% of all patients with hydatid cyst disease, whereas 50% of bone hydatidosis cases are spinal. Diagnosis is difficult and patients usually present with neural compression symptoms. Surgery and antihelmintic medicine administration are considered as the treatments of choice. Methods. In this report, a 35-year-old male patient, who underwent surgical and antihelmintic medical treatment 2 years previously, had a leaking cyst without neurologic symptoms. The patient underwent excision of multiple parasacral cysts from a posterior approach. Medical antihelmintic treatment was used after surgery. Results. The postoperative period was uneventful. Followup MRI scans were performed at 6, 12, and 18 months after surgery. The few residual anterior perisacral cysts had, in fact, become smaller. Conclusion. The recurrence period of spinal hydatid disease may be silent without any neurologic deficits or pain; the only clinical manifestation may be leakage from a cyst. Curative therapies remain unlikely, but periodic follow-up MR images are advisable for early diagnosis of recurrence in order to obtain effective treatment.