The perforation problem in hydatid disease

Hydatidosis (echinococcosis) is endemic in the Mediterranean region, including Turkey. We evaluated the problem of perforation in hydatidosis. The clinical data on 21 patients with intra-abdominal hydatid cyst perforation who were treated in the last 10 years were evaluated retrospectively. Twelve patients (57%) were men and nine (43%) were women. Their average age was 40 (range = 20-65). Blunt trauma was the etiologic mechanism in four cases (19%). Except for a case with a cyst in the left inguinal region, most (95%) of the patients had primary hepatic hydatidosis (95%). The procedures used on the 30 cysts found in 21 patients were as follows: partial cystectomy and drainage in 21 (70%), total cystectomy in 5 (17%), partial cystectomy plus omentopexy in 2 (7%), and drainage plus vacuum obliteration in 2 (7%). The average postoperative hospital stay was 12 days (range = 6-30). Two patients (10%) had complications: an incisional hernia developed in one patient, and a gastrocutaneous fistula developed in the other. Albendazole (10 mg/kg/day) was prescribed for two months. The mean follow-up time was 80 months (range = 6-131). Three patients (14%) underwent additional surgery for recurrence at various times. The morbidity and mortality associated with perforated hydatid cysts were higher when compared with that of nonperforated cysts. Hydatidosis is endemic in Turkey and traffic accidents are common. When these factors coexist, hydatid perforation should be considered in trauma patients with stable hemodynamics, but suspicious abdominal findings. The choice of the operative approach should be based on the experience of the surgeon and regional characteristics.