Cysticercosis Infested Pectoralis Major Myocutaneous Flap Reconstruction: An Ethical Dilemma
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CLINICAL REPORT
Cysticercosis Infested Pectoralis Major Myocutaneous Flap Reconstruction: An Ethical Dilemma Abhijeet Singh1 • Anand Subash2 • Kinjal Majumdar1 • Bhinyaram1
Received: 18 June 2020 / Accepted: 27 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Disseminated cysticercosis is a rare manifestation of cysticercosis, a relatively common tropical disease in Asia, Africa and South America. Here the embryo of pork tapeworm Taenia Solium gets disseminated to multiple organs and tissues via hepatoportal system. we report here a 45 year gentleman with stage IV oral malignancy who was incidentally found to have disseminated cysticercosis on pre-operative work up. Along with the management of primary cancer and new found asymptomatic disseminated cysticercosis, the ethical challenge was to choose an appropriate reconstructive option for the composite oral cavity resection defect, since all the skeletal muscles in body where studded with cysticercosis larvae. We couldn’t find any such report in literature to resolve our dilemma. After surgical board discussion, we zeroed down to pedicled pectoralis major myocutaneous flap, the most versatile and workhorse flap for head and neck reconstruction. Eventually the patient underwent surgery and adjuvant radiotherapy without any delay. He was simultaneously treated with oral albendazole under steroid cover and remained complication free at 2 years. Keywords Cysticercosis Myocysticercosis Pectoralis major myocutaneous flap Taenia solium Oral cancer
& Bhinyaram [email protected] 1
Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
2
Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bangalore, Karnataka 560024, India
Introduction Cysticercosis is a parasitic infection caused by Cysticercus cellulose, the encysted larval stage of pork tape worm Taenia solium. Its normal life cycle passes through a definitive host, (human) harboring the adult worm and an intermediate host (pig) harboring the myocysticerci [1]. Humans may incidentally become an intermediate host via faecal-oral transmission from the T. solium eggs or consuming under-cooked pork meat, which brings a false dead end to its life cycle. The embryos are disseminated via intestine through the hepato-portal system to the tissues and organs of body. This leads to a condition called Disseminated cysticercosis (DCC), where almost any organ of the body may get infested with the cysticerci. The most commonly infested organs are skeletal muscles, lungs, brain, orbit and rarely cardia [2]. The larva may then remain as subcutaneous nodule, myocysticercosis, neurocysticercosis that may get calcified over time. The usual presentation in an immunocompetent patient is of a solitary lesion in muscles or brain. The degree of clinical manifestation depends on the parasite location, the parasitic load and the host tissue interaction [3]. While the neurocysticercosis cases often presents with seizure episode, other sub
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