Echinococcosis (Hydatid Disease): Review and Report of a Case of Secondary Echinococcosis

Echinococcosis is a disease caused by the larval form of Echinococcus granulosus. The adult worm lives parasitically in the intestine of the definitive host, the dog, wolf and other wild carnivores. The ova, which are passed in the feces, are ingested by grazing animals. The intestinal juices free the ovum from its cuticle and, having entered a capillary, it is carried by the blood stream to the liver or lung, where it develops into a hydatid cyst. Man becomes infected by ingesting contaminated vegetables or drinking contaminated water.

In a mature hydatid cyst there may be thousands of scolices and each one of these, if released from the hydatid cyst, may form a new cyst if it is planted in a suitable environment. Hydatid cysts are most commonly found in the liver and the lung, but may occur in other organs.

A hepatic cyst may rupture into the peritoneal cavity and produce a hydatidoperitoneum. A pulmonary cyst frequently ruptures into a bronchus and is thus evacuated.

The disease is of world-wide distribution. In Canada most of the cases of this disease have occurred among Indians and Eskimos. It is now known that a sylvatic cycle has been established in North America and that it serves as a source of infection of the dog and man.

The patient reported herein had spontaneous rupture of a hepatic hydatid cyst, with subsequent development of secondary peritoneal echinococcosis. Repeated laparotomies had to be performed to relieve pressure on or obstruction of various organs. The patient made an uneventful recovery and is again usefully employed. No effective medical treatment for this disease is available.

     

Splenic hydatid cyst perforating into the colon manifesting as acute massive lower gastrointestinal bleeding: an unusual presentation of disseminated abdominal echinococcosis

Hydatid disease can occur in all viscera and soft tissues, although the liver and the lungs are the organs most commonly involved. Isolated splenic involvement with the disease is extremely rare. Splenic hydatid cysts may suppurate, fistulise to adjacent organs, or rupture into the peritonaeal cavity. However, acute, massive lower gastrointestinal bleeding due to splenocolic communication resulting from splenic echinococcal cyst has not been previously reported. We present a 77-year-old woman with disseminated abdominal echinococcosis, and active lower gastrointestinal bleeding due to splenocolic fistula resulting from splenic hydatid cyst. She was treated successfully with en-bloc excision of the spleen and splenic flexure of the colon.     

Clinics in diagnostic imaging (102)

A 19-year-old man presented with cough and haemoptysis of ten days duration. He also had mild right hypochondrial pain. Chest radiograph and computed tomography (CT) showed a rounded soft tissue density opacity with an air crescent sign. CT showed multiple cystic lesions in the liver with a daughter cyst in its lateral wall. Diagnosis of hydatid disease of lung and liver was made. The contents of the liver cyst were aspirated, hypertonic saline instilled, re-aspirated, and absolute alcohol injected. Hydatid disease is endemic in certain parts of the world. Although the lungs and liver are most frequently affected, the disease can arise in any part of the body and should be kept in differential diagnosis whenever a cystic lesion is encountered. Hydatid cysts typically demonstrate characteristic imaging findings, however, the appearances may become complicated due to cyst rupture or secondary infection. Ultrasonography is the imaging modality of choice particularly in hepatic disease. CT best demonstrates cyst wall calcification and cyst infection.     

Diagnosis and management of hepatic hydatidosis complicated with biliary fistula.

A total of 1,204 patients with liver hydatidosis were treated by operations in our hospital from 1953 to 1990. Of these 74 had biliary fistulae. Growth of echinococcus cyst causes displacement, distortion and stenosis of the hepatic ductules with impaired bile drainage. Biliary effusion may occur between the endo- and ecto-cyst walls. Long term compression renders the hepatic ductule atrophic, and liable to rupture, forming a hydatid cyst-biliary fistula. The hydatid cyst can rupture into the biliary tract, and cyst fluid escapes into the biliary tract with daughter cysts discharged into the common bile duct, causing biliary colic, obstructive jaundice and possibly liver abscess. For acute obstructive and suppurative cholangitis, drainage of purulent bile and daughter cysts and management of the infected hydatid cyst are indicated. After removal of the echinococcus cyst, the fistulous opening on the hepatic duct must be sutured, but a small biliary fistula may be left alone. According to the thickness of the ectocyst wall, size of the cavity, severity of the infection, and degree of bile leakage, one of the following operative procedures for obliteration of the residual cavity can be selected: (1) closure by inversion suture of ectocyst; (2) omental or muscle flap obliteration; (3) closed catheter drainage.

     

Primary orbital hydatid cyst: computed tomography and magnetic resonance imaging findings

Orbital hydatid cyst is a rare form of hydatidosis, comprising less than 1% of all hydatid cysts reported. The first choice of treatment for orbital hydatid cyst is surgery. Preoperative diagnosis is important, so as to avoid rupture of the cyst and prevent the spread of the parasitic disease. Herein, we present the computed tomography and magnetic resonance imaging findings of a case of primary orbital hydatid cyst.     

Splenic recurrence of liver hydatid cyst and spleen preserving therapy

Hydatid cyst disease remains a considerable public health problem, especially in pastoral and farming regions. Although the spleen is the third most commonly affected organ after the liver and lungs, splenic hydatid cyst is an uncommon entity even in areas that are endemic for echinococcosis. The recurrence rate after surgical therapy of the liver hydatid cyst is reported as 6.8-22.3 percent. Recurrences most frequently occur in the liver. Extrahepatic recurrences occur in the lung or peritoneum and the serosa of the abdominal organs. Splenic recurrence of liver hydatid cyst has not previously been reported. The most common surgical therapy is splenectomy, and the other option is spleen preserving surgery. We report the first case of recurrent splenic hydatid cyst in the spleen and liver synchronously after surgical therapy for liver hydatid disease. The patient was treated with liver resection and spleen preserving surgery.     

48例肝包虫病诊治体会

目的探讨48例肝包虫患者的诊治体会。方法对1999-01~2005-06间收治的48例肝包虫病例资料进行回顾性分析。方法:外囊缝团术(8例),内囊摘除外囊缝合引流术(30例),网膜填塞术(10例)等处理方法。结果术后合并胆漏29例,均自愈。目前未见复发的病例,48例患者均获满意疗效。结论肝包虫病治疗以外科手术治疗为主,穿刺需谨慎,术中根据不同的情况采取不同的、合理的措施,可以获得满意的治疗效果。     

Cardiac echinococcosis: echocardiographic diagnosis with a fatal clinical outcome

Hydatid disease HD is an endemic disease found in various regions of the world. The organs mostly affected are the liver and lung. Cardiac involvement in HD is rare. The symptoms are mainly due to the mass effect of the calcific hydatid cyst obstructing the blood or the lymphatic vessels. Other manifestations are secondary infection or cyst rupture in the involved organ. Here, we report a middle aged female patient with no history of medical illness who presented to the emergency room with an unrecordable blood pressure. Echocardiogram showed multiple calcific cysts of echinococcosis granulosa in the left ventricle cavity. In the clinical setting, where there is detection of HD elsewhere in the body, an echocardiogram is mandatory as cardiac involvement is serious and may be fatal.     

Spontaneous intraperitoneal expulsion of an unruptured hydatid cyst

We report a 43-year-old man with a 20 x 20 cm hydatid cyst, spontaneously extruded out from the left lobe of the liver. This complication of hydatid cyst has not been recorded earlier, and makes the case unique in itself and worth reporting. The patient presented with a rare complication of biliary peritonitis of hydatid disease.     

An extremely large primary omental hydatid cyst: report of a rare case

Hydatid disease is a parasitic infection caused by Echinococcus granulosus (larval form) in humans with lesionsmost frequently encountered in the liver and lungs. It can rarely involve extra-hepatic organs. It is endemicin some regions of Iran. The omental hydatid cyst is a very rare manifestation of the disease. This report presentsthe interesting case of a very large omental hydatid cyst.     

Hydatid cyst of liver

Hydatid disease of the liver is still endemic in certain parts of the world. The diagnosis of non-complicated hydatid cyst of the liver depends on clinical suspicion. Ultrasonography and computed tomography, the most important diagnostic tools, are helpful for determining the complications and planning treatment. The modern treatment of hydatid cyst of the liver varies from surgical intervention to percutaneous drainage or medical therapy. Surgery is still the treatment of choice and can be performed by the conventional or laparoscopic approach. Percutaneous drainage and treatment of the cyst with hypertonic saline or alcohol seems to be a good alternative to surgery in selected cases.     

37例肝囊型包虫破入胆道诊治分析

目的： 探讨肝囊型包虫破入胆道的诊断和治疗经验.方法： 对37例肝囊型包虫破入胆道患者的临床资料进行回顾性分析,采用腹部超声（SUG）、CT、核磁共振胆胰管造影（MRCP）、内镜逆行胰胆管造影（ERCP）分别检查37、22、12、4例,36例患者施行肝包虫内囊摘除及残腔引流术,其中31例行胆总管探查“T”型管引流术,4例经胆囊管置引流管胆总管减压,1例行Roux-en-y胆总管空肠吻合术, 1例内囊摘除术后患者内镜十二指肠乳头切开清理胆道引流术.结果：SUG、CT、MRCP均能准确诊断包虫囊肿,对胆道扩张的诊断率分别为67.6%、77.3%、100.0%,ERCP对胆道扩张、胆总管内包虫内囊和（或）子囊碎片及包虫囊肿与胆管相交通的诊断率均为100.0%.术中胆瘘口缝合的19例患者中2例出现术后残腔胆瘘,而未缝合的17例中8例出现胆瘘, 缝合者平均住院10.9 d, 未缝合者平均住院18 d （P＜0.05）.结论： MRCP检查对高度可疑肝囊型包虫破入胆道患者具有诊断准确和无创等优点,ERCP不仅对该病有确诊意义,而且可对该病术后并发症实施有效的治疗.缝合胆瘘、胆道减压是治疗肝囊型包虫破入胆道的简单、安全、有效且并发症少的方法,而术中胆道造影和胆道注射亚甲蓝是发现胆瘘口的有效的手段.     

Huge omental hydatid cyst: a case report

Omental hydatid cyst is a rare cause of intra-abdominal hydatids. A 38-year-old female was presented with complaint of progressive abdominal distension. USG revealed a cystic lesion involving almost whole of the abdominal cavity. The patient was operated on and the cyst was removed followed with a course of albendazole.     

肝包虫破入胆道15例临床分析

目的：探讨肝包虫破入胆道的诊断和治疗方法。方法：B超诊断肝包虫病及肝包虫破入胆道造成的胆道阻塞,对确诊及高度可疑的患者施行肝包虫内囊摘除并进行肝包虫残腔引流、胆总管探查、“T”型管引流术。结果：全组无术后严重并发症及死亡病例,均顺利康复,平均术后12d出院,2例病人残腔感染经持续引流治疗后好转。结论：B超是该病有效的检查方法。及时的胆道探查引流、清除包虫内囊及残腔引流是该病有效而安全的治疗方法。     

肺包虫囊肿的影像学诊断

本文总结了４５８例肺包虫囊肿影像学诊断经验。典型Ｘ线征除罕见的环形囊壁鲈化外,只有破裂后形成液平面,上有漂浮膜或内囊周围有液体及气体形成双液平面。ＣＴ扫描包虫囊肿密度均匀,ＣＴ值２０Ｈｕ以下,偶见囊中之囊。Ｂ超声囊肿呈圆形或椭圆形无回声区。     

Surgical management of primary retroperitoneal hydatid cyst

Hydatid disease is caused by the cystic stage of infestation by Echinococcus granulosus. Most hydatid cysts occur in the liver followed in frequency by the lung but no site is immune. Hydatid disease of the retroperitoneum is a rare condition. A case study is described here of a 30-year-old female with diagnosis of hydatid cyst of retroperitoneum which was treated surgically.     

肾包虫囊肿的CT诊断(附3例报告)

本文报告经手术证实的3例肾包虫囊肿的CT表现。其特征性表现是:(1)卵圆形或圆形水样密度囊肿。(2)母囊内有子囊。(3)囊膜剥离征象。(4)囊壁钙化。并讨论了本病的破裂感染和与先天性肾囊肿的鉴别诊断。     

Life-threatening liver laceration with arterial hemorrhage complicating percutaneous treatment of hepatic hydatid cyst

We present a 76-year-old woman known to have a large right hepatic lobe hydatid cyst which recurred twice after surgical excision. CT-guided percutaneous alcohol ablation was conducted to sclerose the cyst, but the procedure was complicated by parenchymal liver laceration and active arterial hemorrhage from a branch of the right hepatic artery. Bleeding was controlled by both endovascular and surgical interventions. Liver laceration with arterial hemorrhage is a rare not previously reported serious complication of percutaneous treatment of hepatic hydatid cyst that may be potentially life-threatening.     

骨桥蛋白在肝包虫动物模型外囊壁中的表达

目的:观察动物模型肝包虫囊壁情况,研究骨桥蛋白(Osteopontin,OPN)在小鼠肝细粒棘球蚴外囊壁中的分布特征及表达相关因素,并探讨其意义.方法:肝包虫动物模型的制作、HE染色观察、免疫组化观察53例小鼠肝细粒棘球蚴外囊壁中OPN及巨噬细胞的表达与分布.结果:HE染色外囊的着色明显较周围巨噬细胞带深,不存在渐变的过程;83%肝细粒棘球蚴外囊壁中有不同程度OPN表达,且集中分布于肝包虫纤维囊壁(外囊),与外侧巨噬细胞带比较有显著差异(P＜0.01).结论:在动物模型上证明了外囊与肝实质间存在可分离间隙,OPN主要分布在肝细粒棘球蚴外囊,并在其形成过程中起重要作用.     

肝包虫术后残腔并发症的防治(附173例报告)

目的讨论肝包虫内囊摘除术后残腔并发症的防治方法。方法回顾分析我院1960年1月至2004年1月肝包虫内囊摘除术后外囊残腔并发症173例,占同期肝包虫手术的17．49％(173／989)。其中残腔感染104例(60．12％),残腔出血2例(1．16％),残腔胆汁漏51例(29．48％),钙化残腔不闭合13例(7．51％),残腔消化道瘘3例(1．73％)。87例(50．29％)经再次手术治疗。结果术后腹腔感染7例(8．05％),伤口感染11例(12．64％),肺部感染4例(4．6％),死亡3例(1．73％)。本组治愈率为98．27％。结论肝包虫内囊摘除术后残腔并发症发生率较高,其中以残腔感染及胆汁漏最为常见,部分病例治疗甚为困难,严重影响病人的生活质量甚至生命。包虫囊肿完整切除可有效地预防术后残腔并发症。近来有人提出包虫外囊与肝组织之间有一层疏松的结缔组织称为“外科膜”,该膜有利于包虫囊肿完整切除。作者认为包虫囊肿完整切除应根据病人的全身及局部情况和术者的经验而定,不可盲目从事。