Hydatid cysts of the brain stem. Two cases

Cerebral hydatid cysts represent 2-3% of all intracranial masses in endemic countries. Its incidence in posterior fossa is very rare. We report two cases of brainstem location. Clinically, the lesion exhibited signs of brainstem tumor. In two patients, CT scan showed a hypodense lesion. There was no enhancement after contrast administration. One patient was explored by MRI; on precontrast images, the lesion appeared homogeneous with hyposignal intensity and smooth limits. T2 weighted MRI and post contrast examination confirmed the cyst nature of the lesion. Surgery was performed in the two patients. The cyst was first aspirated and its membrane was then removed. Post operatively, one patient died, the other one is still alive but severely affected two years later. CT scan showed total disappearance of the cyst. The clinical presentation, radiological findings and surgical procedures are discussed.     

Hilar biliary cysts in hepatic transplantation. Report of three symptomatic cases and occurrence in resected liver grafts

Hilar cysts are infrequent post-transplant biliary tract complications. Thirteen cases were discovered among 493 consecutive liver transplants (2.6 %). Three (0.60 %) were symptomatic (obstructive jaundice) while the other ten were found by systematically searching in the hilum in a series of 129 consecutive, resected grafts at retransplantation or autopsy (n = 54). Two types of cysts were detected: in eight grafts (1.6 %), these were blind unilocular cavities with viscid mucous content, located adjacent to the biliary tract anastomoses. These had been inadvertently created as a result of the sequestered remnant cystic duct after cholecystectomies and biliary tract reconstructions, where a double-barreled common duct and long cystic duct had been present in the donor liver. These mucoceles ranged from 0.5 to 5.5 cm in diameter (median 1.7 cm). The three symptomatic cases were diagnosed by imaging techniques 3.5 years after transplantation; however, this type of cyst was found as early as the 2nd month post-transplantation when detected in lost liver grafts. Five livers (1 %), lost between 5 months and 2.8 years post-transplantation, showed cystically dilated peribiliary glands, sometimes with multilocular, and occasionally multiple, cavities ranging from 0.5 to 2 cm in diameter (median 0.8 cm). This type of cyst was asymptomatic and located adjacent to the left, right, or common hepatic ducts. Threads were found near four cysts, suggesting that surgical injury may have been responsible for obstructing the neck of the glands. With the increasing number of long-term survivors of liver transplantation, unless preventive surgical methods are implemented, the number of symptomatic cysts of these origins can be expected to grow. Transplantation teams should, therefore, be aware of these potential causes of biliary tract complications. Received: 3 June 1997 Received after revision: 21 October 1997 Accepted: 19 November 1997     

Hydatid cysts of the spleen. Apropos of 25 cases

Based on a series of 25 cases of hydatid cyst of spleen, the frequency of this localization, the clinical latency and the often serious complications of these lesions are emphasized. Ultrasound was found to be an excellent diagnostic examination. Treatment in all cases was radical excision and therapy to associated lesions, with a simple postoperative course in all cases.     

Hydatid cysts of liver and portal hypertension

Two cases of portal hypertension due to hydatid cysts of the liver are reported. In one of the patients, symptoms were secondary to obstruction of inferior vena cava and hepatic outflow tract. The other patient was operated on with a diagnosis of extrahepatic presinusoidal portal hypertension caused by extrinsic compression of the liver by an hydatid cyst. Although hydatidosis is a benign disease, it can produce serious complications as in these reported cases. Therefore hydatidosis should be remembered amongst the causes of portal hypertension in countries where the disease is endemic.     

Hydatid cysts of the hepatic dome. Apropos of 124 cases]

The authors report a series of 124 hydatic cyst of hepatic dome. The discovery circumstances are represented by evolutive complication: infections in 58%, angiocholitis 45%, vascular compression 7.2% and bilio-bronchic fistulas in 6.4%. The treatment realised was the resection of the bulging dome in 87%, of cases parietal perikystectomy was realised in 9.6% and total perikystectomy in 3.2%. They deplore 12 deaths (9.8%).     

Hydatid cysts in children: report of 88 cases

Eighty-eight children (37 female, 51 male) with hydatid cyst disease were treated at the Pediatric Surgery Clinic of Ankara SSK Hospital, Turkey, in the period from 1977 to 1987. The ages of the children ranged from 3 to 14 years; 79 (89.8%) were older than 6 years and only nine (10.2%) were under 6 years. Liver and lung were the most frequent sites of involvement. Various surgical techniques were used in the treatment of the cysts. In this series obliteration of the cyst cavity by suturing (capitonnage) and omentopexy proved to be the best choice of surgical treatment in order to minimize the morbidity.     

Hydatid cyst of the kidney. Report of 45 cases

The kidney is a rare site of hydatid disease. It remains clinically silent for a long time and only presents at the stage of complications. The diagnosis is essentially radiological. Renal hydatid cyst (RHC) raises therapeutic problems due to its complications, which sometimes make kidney-preserving cyst resection surgery difficult. The authors report a series of 45 cases of RHC treated in their department during a 20-year period. This series consisted of 27 men and 18 women with a mean age of 47 years (26-80 years). The clinical features were dominated by pain (80%), flank mass (42%), hydaturia (22%), haematuria (13%), urinary tract infection (6%), hypertension (3%). IVU, performed in all patients, showed calcifications in 35% of cases, renal tumour syndrome in 71% of cases and silent kidney in 22% of cases. Surgery was usually performed via a lumbar incision (75%) or a BARAYA incision (15%). Treatment consisted of 18 cyst roof resections (40%), 6 pericystectomies (13%), partial nephrectomy in 2 cases (4%) and total nephrectomy in 18 cases (40%). The postoperative course was marked by urinary fistula in two patients and one death at the 2nd postoperative month related to associated renal sarcoma. The objective of this study is to analyse the epidemiological, pathological and therapeutic features of this disease, which still constitutes a public health problem in Morocco.