title: Eradication of advanced pelvic hydatid bone disease after limb salvage surgery - 5-year follow-up: a case report.
abstract: BACKGROUND
  Echinococcosis is produced by the larval stage of Echinococcus granulosus; it is a parasitic disease which is seen rarely in humans and has adverse outcomes. We report a case of advanced pelvic hydatid bone disease with successful limb salvage surgery. Our patient had a 5-year follow-up without recurrence which is a rarity as per the literature. Early diagnosis and prompt medical therapy are necessary for effective management whereas delayed diagnosis is always fraught with the risk of recurrence and sepsis.
  
  
  METHODS
  In 2009, a 30-year-old woman, native of Karachi (Sindhi ethnicity), presented at our clinic with history of a pathological fracture 11 years earlier. Her fracture was initially misdiagnosed and fixed. Subsequently she had persistent disease that progressed with time. Following this she underwent multiple surgeries and the diagnosis of hydatid disease was made but despite multiple debridements and medical therapy she was not cured and finally she was offered a hemipelvectomy (limb sacrifice). On presentation to our hospital she was counseled regarding options of hemipelvectomy versus a limb salvage form of modified internal hemipelvectomy and wide margin resection. She opted for limb salvage. She underwent internal hemipelvectomy with wide margin resection of soft tissue and proximal femur along with postoperative albendazole therapy. She was able to walk again after a very long period. Currently she is 5-years postreconstructive surgery. She is infection free and ambulant without support.
  
  
  CONCLUSIONS
  Hydatid bone disease is a rare entity in our part of the world but a careful history and thorough look at the initial images of our patient would have led to the suspicion of pathologic fracture and subsequent early diagnosis of this difficult problem. A second important learning point in this case was the lack of early referral to a center where this difficult problem could have been handled effectively. This could have minimized the physical, mental and financial stress to the patient and her family.
authors.affiliation: Department of Orthopaedics, Shah Bhitai District Government Hospital, Hyderabad, Pakistan. khan.shahid1945@gmail.com.
authors.forename: Muhammad Shahid
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Head Section of Orthopaedics, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. pervaiz.hashmi@aku.edu.
authors.forename: Pervaiz Mehmood
authors.initials: PM
authors.lastname: Hashmi
authors.affiliation: Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan. dawar.khan@aku.edu.
authors.forename: Dawar
authors.initials: D
authors.lastname: Khan
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D001847:Bone Diseases / Q000188:drug therapy / Q000469:parasitology* / Q000601:surgery*; D004443:Echinococcosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006428:Hemipelvectomy; D006801:Humans; D023821:Limb Salvage; D010384:Pelvic Bones / Q000469:parasitology* / Q000601:surgery
chemical_list: D000871:Anthelmintics; D015766:Albendazole