Hydatid cyst of the kidney

Hydatidosis is an endemic disease caused by the larval form of Echinococcus Granulosus. Renal involvement represents less than 5% of confirmed cases. It remains clinically silent for a long time, and only presents at the stage of complications. Diagnosis is suspected on the basis of epidemiological, clinical, radiological and biological data. There are various clinical presentations. Hydaturia, which is observed in 10 to 30% of the cases, is the only pathognomonic feature. Diagnostic accuracy has been improved since the wide use of ultrasonography. Computed tomography and magnetic resonance imaging are helpful tools to confirm the diagnosis. The treatment is mainly based on surgery. The resection of the prominent dome remains the standard option as it allows preservation of the kidney. Total nephrectomy should be proposed only in case of renal destruction. The percutaneous management, which includes puncture, aspiration, injection, and reaspiration, can be performed in very selected cases. However, the results of this technique are still under debate.     

Hydatid disease of rib

Osseous hydatidosis, especially when located in the rib, is a very rare disease. In 1978, only 39 costal echinococcosis cases were published. The course of the disease is generally slow and laboratory tests are frequently negative. Diagnosis is generally made through the combined assessment of clinical, radiologic, and laboratory data. Living in a rural area is an important risk factor for the disease. The gold standard for therapy is radical removal of the involved ribs or chest wall. We present the case of a 63-year-old herdsman with costal echinococcosis and a review of the literature.     

Hydatid disease of bone

A case of primary hydatid disease of the right femur is reported that presented with pathological fracture and was diagnosed at the time of exploration for biopsy. The patient was treated by removal of all cysts, irrigation with scolicidal solution, bone grafting and immobilisation of the fracture followed by four cycles of oral Albendazole. Eosinophilia and serological tests reverted to normal but the patient died due to acute myocardial infarction six months later. This uncommon condition should be considered in the differential diagnosis of pathological fractures, bone pain or osteolytic lesions, especially in patients of rural and farmer background.     

Hydatid disease of the liver

Echinococcus granulosus remains a clinical problem in sheep and subsistence farming communities in South Africa. The most commonly affected organs are the liver and the lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. Clinical examination is unreliable in making the diagnosis. Serological testing has a broad range of sensitivity and specificity and is dependent on the purity of the antigens utilised. Ultrasound examination of the abdomen is gens utilised. Ultrasound examination of the abdomen is both sensitive and cost effective. Computed tomography and endoscopic retrograde cholangiopancreatography (ERCP) are reserved for complicated cases. The differential diagnosis includes any cystic lesion of the liver. Liver hydatid cysts can be treated by medical or minimally invasive (laparoscopic and percutaneous) means or by conventional open surgery. The most effective chemotherapeutic agents against the parasite are the benzimidazole carbamates, albendazole and mebendazole. Albendazole is more efficacious, but recommended treatment regimens differ widely in terms of timing, length of treatment and dose. Medical treatment alone is not an effective and durable treatment option. PAIR (puncture, aspiration, injection, reaspiration) is the newest and most widely practised minimally invasive technique with encouraging results, but it requires considerable expertise. Open surgery remains the most accessible and widely practised method of treatment in South Africa. The options are either radical (pericystectomy and hepatic resection) or conservative (deroofing and management of the residual cavity). Various scolicidal agents are used intraoperatively (Eusol, hypertonic saline and others), although none have been tested in a formal randomised controlled trial. Laparoscopic surgery trials are small and unconvincing at present and should be limited to centres with expertise. Complicated cysts (intrabiliary rupture and secondary infection) may require ERCP to obtain biliary clearance before surgery, and referral to a specialist centre may be indicated.     

Hydatid disease of the heart

A 27-year-old physical education teacher, from a rural sheep farming area of South Africa, was referred following an isolated episode of collapse. Transthoracic echocardiography and MRI showed a cystic lesion under the septal leaflet of the tricuspid valve attached to the right ventricular wall. A provisional diagnosis of hydatid cyst was made. Hydatid serology was negative and there was no evidence of hydatidosis elsewhere. Preoperatively, the patient was treated with praziquantel and albendazole. Surgery was performed using cardiopulmonary bypass. Cyst was excised without any spillage. The patient was weaned off bypass without any support and made an uneventful recovery. Cytology and microbiology of the specimen confirmed hydatid pathology. This case describes excision of a right ventricular hydatid with techniques used to avoid spillage. It also describes an up-to-date antihelminthic therapy used in the management of hydatid cysts.     

Hydatid disease of the liver

Twenty cases of hyadatid disease of the liver are described. The clinical manifestations of hydatid cyst of the liver and diagnostic procedures such as ultrasound and computerized axial tomographic scan of the liver are presented. In the last 10 cases, aspiration of hydatid fluid without opening the exocyst initially reduced the incidence of complications significantly. The application of a vacuum suction to the exocyst postoperatively enhances liver regeneration.     

Hydatid disease of the liver

Our experience in the surgical management of hydatid disease of the liver in 212 patients over the past eighteen years is reviewed. The most frequent postoperative complications and mortality rates of elective and emergency procedures are presented, and the more frequently utilized operative technics are described.In the great majority of patients conservatism was the rule in excision of solitary or multiple cysts. It is important to establish whether or not hepatic cysts communicate with the biliary tree. In these cases, enteroanastomoses (such as cystjejunostomy or cystgastrostomy) may be utilized depending on the position of the cyst. Any associated biliary disease (such as lithiasis or fibrosis) should be taken care of at the same time. External cystic drainage (marsupialization) is contraindicated because of the high incidence of chronic external biliary fistula, secondary hemorrhage, sepsis, and postlaparotomy hernia. In those patients in whom the cyst has penetrated the diaphragm and communicates with the lung, treatment should be carried out in one stage whenever possible.     

Hydatid disease of the lung

A total of 1,022 patients with hydatid disease were treated by surgical operations in our hospital, 201 of whom had lung echinococcosis. The criteria for diagnosis were (1) a history of living in an area where hydatid disease prevailed and of contact with dogs or their contaminated environment; (2) pressure symptom in the lungs produced by larger hydatid cysts, concomitant infection that provoked pulmonary abscess, concomitant rupture into the bronchi with the abrupt onset of a barking cough, and rupture into the thoracic cavity causing acute pleural effusions; (3) positive results of Casoni's intradermal test as high as 82.3 percent; (4) typical roentgenoscopic findings, such as a round or ovoid shadow with a regular margin, definite limits, and uniform density that is unifocal or multifocal. Specific images described in this report may also be observed. Two procedures for treatment were adopted: for intact endocysts, a meticulous incision was made along the ectocyst wall and then the endocyst was extracted, and for endocysts that had previously lost fluid, puncture was used. After removal of the endocysts, appropriate suturing of bronchial fistulas and of residual loculi of the ectocysts in the lungs carried out to prevent infection.