Isolated Mesosigmoidal Hydatid Cyst as an Unusual Cause of Colonic Obstruction: Report of a Case

We report herein an unusual case of primary mesosigmoidal hydatid cyst that presented as acute left colonic obstruction mimicking sigmoid colon cancer. A 61-year-old man with a 3-day history of abdominal pain, distention, obstipation, vomiting, and fever was admitted to the emergency department of our hospital. Surgery was performed under a presumptive diagnosis of acute left colonic obstruction. The intraoperative findings were highly suggestive of sigmoid colonic carcinoma and Hartmann's procedure was performed. Histopathological examination of the pathological specimen revealed an isolated hydatid cyst embedded in mesosigmoid which had caused mechanical sigmoidal obstruction. Primary extrahepatic, intra-abdominal localization of a hydatid cyst is not unusual. Therefore, as a hydatid cyst may cause a wide variety of clinical syndromes, it should be kept in mind in the differential diagnosis of mechanical bowel obstruction, especially in endemic regions. Received: December 11, 2000 / Accepted: May 15, 2001     

破裂肝包虫囊肿的处理(附149例报告)

目的探讨破裂肝包虫囊肿的诊治方法。方法回顾分析我院1960年6月至2003年6月手术治疗的破裂肝包虫囊肿149例。其中破人腹腔13例（8．72％），消化道穿破8例（5．37%），泌尿道5例（3．36％），肝包虫囊肿一胆道一支气管瘘8例（5．37%），破入胸膜腔9例（6．04％），胆道穿破103例（69．13％），其他部位穿破3例（2．01％），均经手术治疗。结果术后伤口感染14例（9．40％），横结肠瘘1例（0．67%），肝包虫复发12例（8．05%），腹腔内复发10例（6．71％），复发病例均经再次或多次手术治愈，死亡3例（2，01％），远期治愈144例（96.64％）。结论肝包虫囊肿破裂是较常见的并发症之一，可引起急腹症、过敏性休克，以破人胆道者为多，可致胆道梗阻甚至急性梗阻性化脓性胆管炎（AOSC），破人消化道、泌尿道、胸腔甚至形成包虫囊肿、胆道、支气管瘘等，治疗多较困难，且易复发，故肝包虫囊肿应早期诊断及尽早手术治疗，以防破裂，进一步开展对包虫病的防治则更为重要。     

Unusual location of hydatid cyst: the posterior leaflet of tricuspid valve

Hydatid Cyst disease involves the heart in 0.02-2% of the cases. It can appear with symptoms very similar to coronary artery disease, cardiac valvular disease and pericarditis. We present a case of hydatid cyst that was located on the posterior tricuspid leaflet and that caused tricuspid regurgitation in 37 year old female patient who has gone through hydatid cyst excision from the bilateral lungs with median sternotomy 2 years ago. In addition to the right atrial and ventricular dilatation, second degree tricuspid regurgitation and significant pulmonary hypertension was found. The 2 x 2 cm smooth surfaced mass was resected from the posterior leaflet of the tricuspid valve and the defect was closed with suture with the aid of cardiopulmonary bypass. The patient followed with long term albendazole treatment. Cardiac echinococcosis should be kept in mind in some patients throughout their life with a history of previous hydatid cyst disease. Surgical excision without rupture is the treatment of choice for cardiac hydatid cyst, with following medical therapy in order to prevent recurrence.     

Hydatid cysts with hepatic and pelvic synchronous location--clinical case

About 75% of all hydatid cysts are located in the liver and they are singular. Extrahepatic hydatid cysts are rare pre- and intra-operative findings. The majority of such locations are consecutive from a hepatic primary. We present the clinical case of a 28-years woman, clinically diagnosed with a pelvic tumor. Ultrasonography and CT-scan showed two large tumors: a 17/10 cm left liver cyst, that contained free floating hyperechogenic hydatid sand and a 12/11 cm pelvic cyst, that displaced the urinary bladder, the uterus, the sigmoid colon and the rectum. The diagnosis of synchronous hepatic and pelvic hydatid cysts was suggested. Explorative laparotomy revealed a large cystic tumor of the left liver, 20/15 cm, with many daughter cysts. The cysts were aspirated through a closed suction system and flushed with hypertonic saline, then its cavity was unroofed and drained. We also found a voluminous hydatid cyst of the pelvis, which was treated in the same manner. After 2 days, a bile duct communication was diagnosed, with a medium biliary output--300-400 ml/day. The fistulography confirmed the connection with the biliary ducts. An endoscopic sphincterotomy was then performed, followed by a favourable evolution. According to the scientific criterias from the literature, we discussed the treatment and the outcome of these extrahepatic locations.     

Primary spinal intradural extramedullary hydatid cyst in a child

BACKGROUND/OBJECTIVE: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. CASE REPORT: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. CONCLUSION: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.     

Management of complicated hydatid cyst of the thorax

BACKGROUND: Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hydatid disease. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical therapy and the delay of surgical treatment in pulmonary hydatid disease. METHODS: Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approach in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%). RESULTS: In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3-17 days). The mean follow up was 18.4 months with no recurrence. CONCLUSION: Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.     

Acute pulmonary embolism due to the rupture of a right ventricle hydatic cyst.

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst (often in the liver) into the venous circulation. We report a case of hydatid pulmonary embolism following rupture of a hydatic cyst in the right ventricle. Pulmonary angiography showed right pulmonary occlusion. Echocardiography, computed tomography scan and magnetic resonance imaging showed images suggesting a hydatid cyst. The patient underwent sternotomy and cardiopulmonary bypass in order to treat the heart cyst and remove the hydatic pulmonary obstruction. A concomitant lung hydatid cyst was extirpated.     

Hydatid Cyst in the Pulmonary Artery: An Uncommon Localization

Abstract Pulmonary artery involvement of hydatid disease caused by the Echinococcus granulosus parasite is an uncommon condition resulting from the opening of a visceral hydatid cyst into the venous circulation or the rupture of a cardiac hydatid cyst. We report a case of a 31-year-old woman with a hydatid cyst located in the right pulmonary artery. Clinical presentation was fatigue, cough, and dyspnea. Diagnosis was made by chest x-ray, computed tomography, and magnetic resonance imaging. The cyst was extracted under total circulatory arrest. Diagnosis and surgical therapy of the intraluminal pulmonary arterial hydatid cyst prevented possible occurrence of severe complications, such as cyst rupture, anaphylactic shock, and sudden death.     

Risk for laparoscopic fenestration of liver cysts

Background: Laparoscopic fenestration is considered the best treatment for symptomatic simple liver cysts. Conversely, the laparoscopic approach for the management of hydatid simple liver cysts is not widely accepted because of the risk for severe complications. Despite improvement in imaging techniques, the probability of preoperatively mistaking a hydatid liver cyst for a simple liver cyst remains about 5%. Therefore, laparoscopic fenestration, planned for a liver cyst could be performed unintentionally for an undiagnosed hydatid liver cyst. Methods: From January 2000 to January 2001, 15 patients with a diagnosis of liver cyst underwent laparoscopy for fenestration. In all cases preoperative serologic and imaging assessment had excluded hydatid liver cyst. To further exclude hydatid liver cyst, preliminary aspiration of the cyst with assessment of cystic fluid characteristics was performed. Results: In two patients with presumedly simple liver cyst, hydatid liver cyst was diagnosed instead at laparoscopy by aspiration of cystic fluid. The procedure was converted to laparotomy with subtotal pericystectomy. Conclusions: The risk of misdiagnosing a hydatid liver cyst for a simple liver cyst, especially in the presence of a solitary cyst, should be considered before laparoscopic fenestration is performed. Intraoperative aspiration of cyst fluid before fenestration can minimize this risk, thus avoiding severe intraoperative and late complications.     

Primary Spinal Intradural Extramedullary Hydatid Cyst in a Child

Abstract

Background/Objective: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease.

Case Report: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal.

Conclusion: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.     

Periventricular hydatid cyst

Periventricular localization of hydatid cyst is very rarely seen. A 5-year-old boy with periventricular hydatid cyst is presented. He had right hemiparesis and focal seizures. Computerized tomographic scan showed a hydatid cyst in the left periventricular area. Hydatid cyst was successfully removed. The postoperative course was uneventful.     

Cardiac involvement of hydatid disease

Objectives|Echinococcosis is a serious health issue occurring in some geographical region of the world. Cardiac involvement is rare and early diagnosis and prompt surgical intervention are critical.Subjects and Methods: Six patients with cardiac hydatid cysts underwent surgical treatment in our institution between April, 1996 and March, 2002. Five of the patients were female and one was male. Average age was 40±5 years with a range of 19 to 72 years. Cysts were located in the right ventricular outflow tract in two patients, the left ventricular outflow tract in one, the right atrial in one, the right ventricular in one and the right atrioventricular groove in one. Five patients were operated on using standard cardiopulmonary bypass techniques, and one was operated on without cardiopulmonary bypass.Results: In the perioperative and the early postoperative period, no cardiac problems was observed. On control echocardiography, a ventricular septal defect was detected in one patient in the late postoperative period. The ventricular septal defect was repaired using standard cardiopulmonary bypass and was closed with a teflon patch. Patients were followed up for a mean period of 3.4±2.5 years. No mortality or recurrence was observed during the follow-up period.Conclusions: When hydatid cyst is diagnosed, the possibility of cardiac involvement should also be investigated. The treatment of cardiac hydatid cyst is surgical extraction of the cyst.     

Concurrent intrapericardial–pulmonary hydatidosis: an unusual multisystem echinococcosis

A 46-year-old male presented with breathlessness for a few months. He had been operated twice for liver hydatid cysts and once for right pulmonary hydatid cysts at other hospitals. Now he was found to have one hydatid cyst in the upper lobe of the left lung and multiple hydatid cysts adjoining left heart border. On computed tomography (CT) scan chest and echocardiography, it was difficult to ascertain whether these cysts were pulmonary or intrapericardial. Left ventricular ejection fraction (LVEF) was 25%. Enzyme-linked immunosorbent assay (ELISA) was positive for hydatid. Left posterolateral thoracotomy revealed dead hydatid cyst in upper lobe of the lung that was removed. Infected mother hydatid cyst was encountered inside pericardial sac. Scores of daughter hydatid cysts, varying in size from 1 to 30 mm, were scooped out intact from the pericardial cavity. There was significant improvement in cardiac activity, once the tamponade effect of hydatid cyst was removed. Pericardium was about 1 cm thick with lot of purulent and necrotic slough. To prevent future constrictive pericarditis, subtotal pericardiectomy was done. Intrapericardial hydatid cyst should be kept in mind whenever it obscures the heart border and patient has features of cardiac tamponade. Early surgical intervention may be required in these cases.     

Primary giant hydatid cyst of the diaphragm.

We report a case of an hydatid cyst of diaphragma in a 34-year-old female who was admitted to our clinic for right basithoracic pain. Magnetic resonance imaging (MRI) reported a giant hydatid cyst including multiple vesicles at the right lower thoracic cavity. Surgical exploration revealed an independent giant diaphragmatic hydatid cyst. We performed cystotomy and more than 200 daughter vesicles were removed from the cyst. The rest of the giant cyst cavity was excised.     

Primary hydatid cyst of the brain during pregnancy

A 26-year-old woman in the 28th week of pregnancy presented with a primary cerebral hydatid cyst manifesting as deteriorating consciousness and weakness in the left arm and leg. Cranial computed tomography revealed an intracranial hydatid cyst. The cyst was surgically removed and albendazole was administered. The patient had a spontaneous vaginal term delivery and no problem was observed in the mother or child. No primary focus was found in the lungs, liver, and other organs. Hydatid cyst is still an important disease. Intracranial hydatid cyst without primary foci in organs such as the liver and lungs is very rare. Primary cerebral hydatid cyst during pregnancy can be successfully treated by surgical and medical intervention.     

Surgical treatment of hydatid cysts of the heart: a report of 3 cases and a review of the literature

Because the clinical signs and symptoms of cardiac hydatid cyst are nonspecific and highly variable, this disease may be difficult to diagnose. In this report, the cases of 3 patients with cardiac hydatid cysts located in the subepicardium are presented.In 2 of the patients the diagnosis was erroneous, and they were operated on for pulmonary hydatid cyst and acute abdomen in provincial hospitals before transfer to our institution. One patient who had an intrapericardially ruptured cardiac hydatid cyst presented with the clinical features of an acute abdomen. A patient with 4 subepicardial cysts had undergone surgery for a cardiac hydatid cyst 10 years before presenting at our hospital. The perforated cyst in this patient was excised while the heart was beating; the 2 other patients were operated on with extracorporeal circulation.The epidemiologic and pathologic features, clinical presentation, complications, diagnostic methods and treatment of cardiac hydatid cyst are discussed in detail in the light of pertinent literature.     

Giant Renal Hydatid Cyst Resembling a Simple Cyst: An Intraoperative Diagnosis

An interesting case of a giant renal hydatid cyst is presented. The big cystic mass detected at ultrasonography (US) and computerized tomography (CT) in a ten-year-old girl looked like a simple cyst. No germinative membrane or any other radiological sign of a hydatid cyst was present. The operation was planned for a simple cyst; but was altered, after an intraoperative diagnostic needle sampling brought out the characteristic fluid of hydatid cyst. We came to the conclusion that hydatid cystic masses may not always present with their characteristic radiological findings; and that extreme caution should be practiced by the radiologist and the surgeon in order to prevent iatrogenic echinococcal dissemination.     

Secondary gallbladder hydatidosis and nonfragmanted germinative membrane sourced obstructive jaundice caused by intrabiliary ruptured hepatic hydatid cyst (a case report): two rare complication of the intrabiliary ruptured hepatic hydatid cyst

Intrabiliary rupture is the most frequently seen complication of the hepatic hydatid cysts. Obstructive jaundice can be seen as a complication of the intrabiliary ruptured hepatic hydatid cysts due to the migrated cystic content into bile ducts. In this study, we present two rare complications seen in a patient who has intrabiliary ruptured hepatic hydatid cyst. Obstructive jaundice and secondary gallbladder hydatidosis depending on to the intrabiliary ruptured hepatic hydatid cyst in a 58-year-old man patient were diagnosed and treated. A large choledochal nonfragmanted germinative membran was found in the choledochus as the reason of biliary obstruction. Hepatic hydatid cyst is a world-wide disease. Intrabiliary rupture must be kept in mind in the patients who has hepatic hydatid cyst and biliary tract problems.     

Laparoscopic management of an isolated primary omental hydatid cyst: A case report and literature review

Primary isolated omental hydatid cysts are extremely rare. Usually, omental hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, we report a case of a primary isolated omental hydatid cyst treated with a laparoscopic approach.We report a 16-year-old female who admitted to hospital with right upper quadrant pain. Abdominal ultrasonography and computed tomography (CT) revealed a cyst located between the liver and right kidney. The cyst was enucleated from the omentum and removed with a laparoscopic approach. Histopathologic examination revealed a hydatid cyst. There was no recurrence during 3 years of follow-up. Primary isolated omental hydatid disease should be considered in patients in endemic regions with intra-abdominal cysts. Laparoscopic surgery seems to be effective and safe for hydatid cysts in accessible locations.     

Recurrent anaphylactic shock as a manifestation of echinococcosis. Report of a case

Hydatid disease, caused by the cestode Echinococcus granulosus, is common in Mediterranean regions, being highly endemic in Greece. Depending on its size, an intact hydatid cyst may be "silent" or may cause symptoms from compression of adjacent organs. Rupture of a hydatid cyst commonly gives to allergic phenomena, which can include anaphylactic shock. A case is presented in which there was a two-year history of recurrent anaphylactic shock due to small, incomplete ruptures of hydatid cyst. The case emphasizes the potentially life-saving importance of early diagnosis of hydatid cyst.