The management of hepatic hydatid cysts: Review of 94 cases

In this retrospective study, 94 patients operated for hepatic hydatid cysts were reviewed to compared the advantages and disadvantages of different operative techniques. The patients were divided into four groups according to the type of operation. Group I consisted of 33 patients with peripherally located small cysts, eligible for excision, who underwent cystectomy. Group II consisted of 28 patients with cysts smaller than 5 cm, not suitable for complete removal, who underwent partial cystectomy with capitonnage. Group III were 21 patients with cysts larger than or equal to 5 cm, not suitable for complete removal, who underwent partial cystectomy with omentoplasty. Infection and biliary communication were not seen in groups II and III. Group IV were 12 patients with infected cyst or intrabiliary rupture who underwent partial cystectomy with external drainage. In group IV, hospital stay was longer than in the other groups (P < 0.05). Group I had the shortest hospital stay (P < 0.05). Group IV had the highest morbidity and recurrence rates (P < 0.05). We concluded that cystectomy is the technique of choice in selected patients, as it is associated with low morbidity, low recurrence rates, and short hospital stay. Omentoplasty is preferred if cystectomy is not feasible. If there is biliary contamination and infection, external drainage, rather than omentoplasty, should be performed.     

Surgical treatment of liver hydatid cysts

Background. The surgical treatment technique for liver hydatic cyst (LHC) cannot be standardized, and the surgical technique should be tailored according to the extent of the cyst and any adjunct complications of hydatid disease. Patients and methods. All patients were treated with albendazole (10 mg/kg/day) for 15 days preoperatively. Total pericystectomy was performed in three patients (7%). Partial cystectomy and its modifications were performed in the remaining 41 patients (93%). Results. A total of 44 patients were operated on for LHC between December 1998 and October 2004 in our center. Patients were evaluated with ultrasonography and computed tomography scan to determine the extent of the disease and preoperative staging. Twenty-four (53%) of these patients were women and 20 were men (median age, 52.5 years; range, 19–81 years). The majority of patients (n=27) had 1 cyst, and the remaining 17 patients had multiple cysts. In four patients (9.1%), daughter cysts were found in the biliary system, and abscesses were present in three patients (7%). Biliary fistula was the most frequent complication (n=5). Three patients had wound infections. Follow-up was complete for 33 patients (75%). The mean postoperative follow-up was 11.9±10.8 months; there were four recurrences during this time. Discussion. The aim should be to provide complete drainage and obliteration of the cavity. Bile leak and biliary obstruction may complicate the postoperative course if bile leakage into the peritoneal cavity and obstruction in the biliary system are missed.     

Percutaneous treatment of hydatid cysts under sonographic guidance

Nine patients (five males, four females) with 14 hydatid cysts were treated with albendazole and percutaneous drainage under sonographic guidance. All but two cysts were hepatic. The average cyst diameter was 81.5 mm (range: 42–180 mm). There were eight type 1 cysts, two type 2, three type 3, and a single type 4. Type 1 and 2 cysts were treated by needle aspiration, type 3 and 4 by needle decompression and catheter drainage. The residual cavity was irrigated with 30% hypertonic saline and injected with absolute alcohol. Biliary fistulization contraindicated alcohol use. All cysts were successfully treated. A single episode of reversible anaphylaxis was encountered. Serial sonographic examinations revealed residual cavities ranging from 10 to 35 mm in diameter. No new cysts were noted during an average follow-up of 9.6 months. The mean hospital stay was 48 hr. Percutaneous drainage of hydatid cysts is a relatively safe and cost-effective procedure.     

Management of hydatid disease of the liver—10 years' experience in a non-endemic area

The incidence of hydatid disease of the liver caused byEchinococcus granulosus in Austria, a nonendemic region in central Europe, is documented over a 10-year period. Since 1984, 28 patients (24 women, 4 men) with hydatid disease of the liver have undergone surgery in our department. A definitive diagnosis was established by combining serological tests (an enzyme-linked immunosorbent assay withEchinococcus multilocularis antigen and an indirect hemagglutination assay withEchinococcus granulosus antigen) and abdominal imaging (computed tomography scan and ultrasonography). Twenty-four patients (85.7%) had uncomplicated echinococcosis; in most of them (16) total closed pericystectomy was done. Four patients (14.3%) had complicated echinococcosis, suffering from intrabiliary rupture and spontaneous perforation into the peritoneal cavity, and in two of these patients (7.1%) pyogenic transformation, one with abscess perforation, occurred. Postoperative complications were significantly more common in patients with complicated echinococcosis and included two bile leaks (necessitating prolonged tube drainage), pleural effusion, atelectasis, and wound infection. One recurrence of hydatid infection due to previous spontaneous perforation required reoperation 4 years after the primary event. The low recurrence rate of uncomplicated echinococcosis (0%) over a mean period of 5.6 years and of 3.6% when peritoneal echinococcosis was included may be the result of the radical surgical technique employed.     

A case of successful renal transplantation for hydatid disease after surgical treatment of disseminated cysts

Hydatid disease is a systemic disorder affecting especially the liver and lungs. Although it is not endemic in Europe, it can be seen sporadically, particularly because of travel and immigration. Severe, multiple organ involvement is quite rare. A 39‐year‐old Kurdish male patient presented with the previous diagnosis of hydatid disease and disseminated cysts in the liver, lung, and left kidney, leading to renal failure and the need for hemodialysis. Following multiple operations, complete eradication of infectious cysts was achieved, and kidney transplantation was performed. After 4 years of follow‐up, the patient is in good condition, especially with normal renal function and no sign of recurrent hydatid disease.     

1例肝、肺、脊柱、脑多部位包虫病的临床治疗

[摘要]?包虫病以肝组织受累较常见,但也可由血液转移至肝外其他组织,如：肺、骨骼及中枢神经系统而致病。而肝外转移发病率低且不宜鉴别,易误诊或漏诊,尤其是出现颅内转移较为罕见,且致残致死率高。本文回顾性分析了1例肝、肺、脊柱多部位包虫病患者的临床治疗过程以及随访结果。该患者以胸背部疼痛、伴双下肢无力行走困难为主要临床表现而就诊。脊柱MRI及CT显示胸椎多椎体骨质破坏并椎间盘感染致胸椎稳定性丧失、继发性椎管狭窄、死骨的形成、坏死物组织压迫刺激脊髓及神经根引起神经症状。入院后在手术条件允许下行后入路胸椎病灶清除、椎管减压植骨融合内固定术,术后规律口服阿苯达唑片,20 mg/kg,1次/d。 3个月后患者自行停药。1年后患者出现包虫病肺部转移,2年后出现包虫病颅内转移而再次入院,但患者入院7 d后死亡。     

Surgical treatment of pulmonary hydatid cysts in pediatric patients

Hydatid cyst is a zoonotic infection that is caused by Echinococcus granulosus and alveolaris, and that can result in endemics in rural regions. Infections caused by Echinococcus granulosus are more commonly seen in our country. In this retrospective study, we aimed at discussing the experience we have accumulated on pediatric pulmonary hydatid cyst cases over the last 6 years. Between 1995-2001, in the Department of Thoracic and Cardiovascular Surgery in Gaziantep University, 38 cases underwent 39 operations due to pulmonary and hepatic hydatid cysts. Of these, 24 were males and 14 were females, with an age range of 2-16 years. Operations were frequently performed via thoracotomy. Nineteen cysts were intact, and 26 were perforated. One case had sternotomy, another had sequential thoracotomy, and the rest of the cases underwent thoracotomy, which resulted in cystotomy-capitonnage. In the postoperative period, 2 patients had sustained air leakage, and 2 other cases developed skin infections. Average hospital stay was 5 days. After the operation, the patients received chemotherapy (albendazole 10 mg/kg/day) for 1.5 months. Early or late deaths or recurrences were not observed. We conclude that cystotomy-capitonnage is a successful treatment for pediatric pulmonary hydatid cysts, as it preserves the parenchyma. Chemotherapy in the postoperative period is beneficial in preventing the recurrences.     

Pleural complications of pulmonary hydatid disease

OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.     

Cardiac hydatid cyst: report of two cases

Cardiac hydatid cyst is life threatening but rare. It is usually asymptomatic and has potentially lethal complications, so early diagnosis with definitive treatment is life-saving. In the present article, we report two cases. The first is a 30-year-old woman with a primary large multivesicular hydatid cyst in the left ventricle. The second is a 17-year-old woman who had multivisceral involvement with a cardiac hydatid cyst, a congenital cardiac anomaly that was an atrial septal defect complicated by pulmonary hypertension. 2-D echocardiography and magnetic resonance imaging confirmed the diagnosis. Surgical treatment was performed using extracorporeal circulation and adjunctive albendazol therapy.     

Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease

Echinococcal infection of the heart is rare. The preoperativefindings, with special attention to two-dimensional echocardiography(2DE), of six patients with cardiac echinococcosis and theirsurgical and pathological correlations are reported. Cardiachydatid cysts (HCs) were located in the cardiac apex in threepatients, in the upper part of the interventricular septum extendingtowards the anterior aspect of the heart in one and in the postero-superiorright atrial wall in another patient. The remaining patienthad multiple intrapericardial cysts. In three patients the cystspresented as well defined, rounded, echolucent masses withinthe myocardial wall bulging into the cardiac chambers. In twopatients, the cysts had ruptured into a cardiac chamber withloss of the characteristic ‘cystic’ appearance;these cysts presented as an echogenic or solid mass protrudinginto a cardiac chamber. Finally, another patient had one HCwith echolucent appearance and another HC in a different locationwith echogenic appearance; this last cyst corresponded to adegenerated HC. In two cases the cyst showed a loculated internalaspect. In one patient the myocardial segment involved by thecyst had a dyskinetic movement. In all six patients, 2DE accuratelydemonstrated the location and morphological details of the cardiaccysts, permitted recognition of the ruptured and/or degeneratedcysts and was superior to thoracic computed tomography and angiographyin the preoperative assessment of these patients. Nuclear magneticresonance imaging (one patient) gave no further informationto that obtained by 2DE. We conclude that 2DE is the techniqueof choice for an early diagnosis of this rare entity.     

Invasive pericardial hydatid cyst: Excision of multiple huge cysts

Cardiac hydatid cyst is rare even in endemic countries, and poses a therapeutic challenge due to varying presentation and unpredictable pre-, peri-, and postoperative complications. We herein present a case of multiple, multifocal, huge pericardial hydatid cyst, with invasion into the left ventricle and main pulmonary artery in a young male patient, presented with atypical chest pain.     

Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease.

Echinococcal infection of the heart is rare. The preoperative findings, with special attention to two-dimensional echocardiography (2DE), of six patients with cardiac echinococcosis and their surgical and pathological correlations are reported. Cardiac hydatid cysts (HCs) were located in the cardiac apex in three patients, in the upper part of the interventricular septum extending towards the anterior aspect of the heart in one and in the postero-superior right atrial wall in another patient. The remaining patient had multiple intrapericardial cysts. In three patients the cysts presented as well defined, rounded, echolucent masses within the myocardial wall bulging into the cardiac chambers. In two patients, the cysts had ruptured into a cardiac chamber with loss of the characteristic 'cystic' appearance; these cysts presented as an echogenic or solid mass protruding into a cardiac chamber. Finally, another patient had one HC with echolucent appearance and another HC in a different location with echogenic appearance; this last cyst corresponded to a degenerated HC. In two cases the cyst showed a loculated internal aspect. In one patient the myocardial segment involved by the cyst had a dyskinetic movement. In all six patients, 2DE accurately demonstrated the location and morphological details of the cardiac cysts, permitted recognition of the ruptured and/or degenerated cysts and was superior to thoracic computed tomography and angiography in the preoperative assessment of these patients. Nuclear magnetic resonance imaging (one patient) gave no further information to that obtained by 2DE. We conclude that 2DE is the technique of choice for an early diagnosis of this rare entity.     

Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease

Echinococcal infection of the heart is rare. The preoperativefindings, with special attention to two-dimensional echocardiography(2DE), of six patients with cardiac echinococcosis and theirsurgical and pathological correlations are reported. Cardiachydatid cysts (HCs) were located in the cardiac apex in threepatients, in the upper part of the interventricular septum extendingtowards the anterior aspect of the heart in one and in the postero-superiorright atrial wall in another patient. The remaining patienthad multiple intrapericardial cysts. In three patients the cystspresented as well defined, rounded, echolucent masses withinthe myocardial wall bulging into the cardiac chambers. In twopatients, the cysts had ruptured into a cardiac chamber withloss of the characteristic ‘cystic’ appearance;these cysts presented as an echogenic or solid mass protrudinginto a cardiac chamber. Finally, another patient had one HCwith echolucent appearance and another HC in a different locationwith echogenic appearance; this last cyst corresponded to adegenerated HC. In two cases the cyst showed a loculated internalaspect. In one patient the myocardial segment involved by thecyst had a dyskinetic movement. In all six patients, 2DE accuratelydemonstrated the location and morphological details of the cardiaccysts, permitted recognition of the ruptured and/or degeneratedcysts and was superior to thoracic computed tomography and angiographyin the preoperative assessment of these patients. Nuclear magneticresonance imaging (one patient) gave no further informationto that obtained by 2DE. We conclude that 2DE is the techniqueof choice for an early diagnosis of this rare entity.     

Acute intraperitoneal rupture of hydatid cysts of the liver: Case series

Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures’ details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.There were 9 men and 6 women. Patients’ age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome.     

Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts

AIM:To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration(PAIR) in the management of hepatic hydatidosis.METHODS:Twenty-six patients with 32 hepatic hydatid cysts had PAIR.Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure.The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle,the cyst was punctured,cystic content(approximately ...     

细粒棘球蚴和多房棘球蚴感染对Balb/c小鼠淋巴细胞亚群的影响

目的 分析Balb/c小鼠感染细粒棘球蚴和多房棘球蚴后脾脏和血液淋巴细胞亚群的变化.方法 利用流式细胞仪分析感染细粒棘球蚴和多房棘球蚴的Balb/c小鼠脾脏和血液中T、B、Th1、Th2、Treg、NK细胞亚群变化.结果 脾脏B、Th1、Th2、Treg细胞在多房棘球蚴感染组和对照组比较,差异有统计学意义;血液Th1和...     

A new percutaneous approach for the treatment of hydatid cysts of the liver

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.     

Forty-four years' experience (1963-2006) in the management of primarily infected hydatid cyst of the liver

Background and aim. The aim of this study was to report our 44-year experience (1963–2006) in the management of primarily infected hydatid cyst of the liver. This is a retrospective review of demographic data, clinical presentation, diagnostic work-up, surgical management, and long-term outcome of patients treated at our center. Material and methods. There were 77 patients with operated infected liver cysts. In the same period, a total of 460 cases with liver hydatidosis were treated surgically. Of those with suppurated cysts, 27 were men and 50 were women, with a mean age 54.5 years. Results. Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. Conclusions. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of “conservative” surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.