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Celik AS, Yosunkaya H, Yayilkan Ozyilmaz A, Memis KB, Aydin S. Echinococcus granulosus in atypical localizations: Five case reports. World J Nephrol 2025; 14:103027. [DOI: 10.5527/wjn.v14.i2.103027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 02/23/2025] [Accepted: 03/20/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Hydatid cyst disease, caused by Echinococcus granulosus, primarily affects the liver and lungs, but it can also develop in rare locations such as the kidneys, thyroid, subcutaneous tissues, bones, and the mediastinum. These atypical presentations often pose diagnostic challenges, as they can mimic benign and malignant pathologies, leading to potential misdiagnoses and inappropriate treatments. Early and accurate detection of hydatid cysts in uncommon sites is crucial for optimal patient management.
CASE SUMMARY This case report series presents five patients with hydatid cysts located in atypical anatomical regions: The kidney, lumbar subcutaneous tissue, gluteal soft tissue, posterior mediastinum, and thyroid gland. The patients exhibited diverse clinical symptoms, including hematuria, palpable masses, localized pain, and chronic cough. Diagnosis was confirmed through a combination of imaging techniques-ultrasound, computed tomography, and magnetic resonance imaging-along with serological testing. All cases were managed with antiparasitic therapy (albendazole), and in selected cases, surgical excision was performed to prevent complications such as cyst rupture or secondary infections. Post-treatment follow-up demonstrated complete resolution or stable cystic lesions, with no signs of recurrence.
CONCLUSION Recognizing hydatid cysts in atypical locations is essential to avoid misdiagnosis and ensure appropriate treatment strategies. Radiological imaging plays a key role in distinguishing hydatid cysts from other cystic and neoplastic conditions, while serological tests can aid in confirmation, particularly in endemic regions. A multidisciplinary approach, integrating radiology, clinical evaluation, and surgical expertise, is critical for effective diagnosis and management. This report highlights the need for increased awareness of extrapulmonary and extravisceral hydatid disease, emphasizing its significance in differential diagnosis and clinical practice.
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Affiliation(s)
- Ayse Sena Celik
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan 24000, Türkiye
| | - Hacer Yosunkaya
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan 24000, Türkiye
| | - Aysel Yayilkan Ozyilmaz
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan 24000, Türkiye
| | - Kemal Bugra Memis
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan 24000, Türkiye
| | - Sonay Aydin
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan 24000, Türkiye
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Martlı HF, Aydın AH, Şahingöz E, Duru D, Er S, Turhan N, Tez M. Evaluation of the necessity of simultaneous cholecystectomy in patients undergoing liver hydatid cyst surgery. Surg Open Sci 2025; 24:61-65. [PMID: 40114678 PMCID: PMC11925524 DOI: 10.1016/j.sopen.2025.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 02/19/2025] [Accepted: 02/24/2025] [Indexed: 03/22/2025] Open
Abstract
Introduction Liver hydatid cysts remain a significant public health issue in Turkey, the Middle East, East Asia, and Russia. Surgical treatments are often employed for certain stages of this disease. However, the necessity of simultaneous cholecystectomy during these procedures remains unclear. Treating symptoms related to subsequent cholelithiasis can become more challenging. This study investigates the necessity of simultaneous cholecystectomy by following patients who underwent hydatid cyst surgery with or without concurrent cholecystectomy. Materials and methods Patients who underwent surgery for hydatid cysts between 2019 and 2024 at the General Surgery Clinic of Ankara Bilkent City Hospital were retrospectively reviewed. A total of 97 patients were included, with 56 (54.32 %) undergoing cholecystectomy along with hydatid cyst surgery (Group 1) and 41 (45.68 %) not undergoing cholecystectomy (Group 2).Preoperative clinical, laboratory, and radiological findings, as well as intraoperative data, morbidity, mortality, and postoperative symptoms, were analyzed. Results Patients in Group 1 had longer hospital stays, higher blood loss, and significantly higher Clavien-Dindo complication scores. In the postoperative follow-up of Group 2, 8 patients (19.51 %) developed stones or sludge, and 1 patient (2.4 %) developed polyps. Four patients (9.75 %) presented to the emergency department with cholecystitis symptoms. A total of 5 patients (12.19 %), including 4 with symptomatic cholelithiasis (9.7 %) and 1 with gallbladder polyps (2.4 %), underwent elective cholecystectomy. Two (40 %) of these cholecystectomies were performed laparoscopically, while three (60 %) were converted to open cholecystectomy. Conclusion Simultaneous cholecystectomy during liver hydatid cyst surgery may prevent difficulties associated with treating symptoms related to subsequent cholelithiasis.
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Affiliation(s)
- Hüseyin Fahri Martlı
- Ankara Bilkent City Hospital, General Surgery Department Üniversiteler Mah. Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Arzu Hazal Aydın
- Department of Pathology, Aksaray University Aksaray Training and Research Hospital, Aksaray 68200, Turkey
| | - Eda Şahingöz
- Ankara Bilkent City Hospital, General Surgery Department Üniversiteler Mah. Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Derviş Duru
- Ankara Bilkent City Hospital, General Surgery Department Üniversiteler Mah. Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Sadettin Er
- Ankara Bilkent City Hospital, General Surgery Department Üniversiteler Mah. Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Nesrin Turhan
- Ankara City Hospital, Pathology Department Üniversiteler Mah. Dumlupınar Cad, Çankaya, Ankara, Turkey
| | - Mesut Tez
- Ankara Bilkent City Hospital, General Surgery Department Üniversiteler Mah. Dumlupınar Cad, Çankaya, Ankara, Turkey
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Sahu A, Naik D, Bal A, Mahalik SK. Primary hydatid cyst of psoas muscle in an adolescent. BMJ Case Rep 2025; 18:e264171. [PMID: 39900394 DOI: 10.1136/bcr-2024-264171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2025] Open
Abstract
Hydatid disease, a zoonotic infection caused by Echinococcus granulosus, primarily affects the liver and lungs but can involve other areas, including muscle tissue, though muscle involvement is rare. This case describes an adolescent girl with a psoas muscle hydatid cyst presenting with abdominal pain, a palpable mass and polymenorrhoea. Imaging and serology confirmed the diagnosis, and treatment included albendazole therapy and surgical excision via transperitoneal laparotomy, followed by a successful recovery with no recurrence at an 18-month follow-up.Hydatid disease is transmitted from definitive hosts, like dogs, to humans. Diagnosis can be challenging due to non-specific symptoms, and it typically relies on ultrasound, CT and serology. Surgical removal combined with antiparasitic drugs remains the primary treatment, though newer methods like ultrasound-guided aspiration are emerging. This case underscores the need to consider hydatid disease in differential diagnoses of cystic masses in endemic areas, particularly in paediatric cases.
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Affiliation(s)
- Avilash Sahu
- Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Deepti Naik
- Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Anandit Bal
- Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Santosh Kumar Mahalik
- Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
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Tepeneu NF, Popoiu CM, Iacob ER, Cerbu S, Belei O, Heredea R. Successful Treatment of Concurrent Cholangiohydatidosis with Obstructive Jaundice and Hepatothoracic Transit in a Pediatric Patient. European J Pediatr Surg Rep 2025; 13:e9-e13. [PMID: 40352816 PMCID: PMC12065639 DOI: 10.1055/a-2590-5917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 04/02/2025] [Indexed: 05/14/2025] Open
Abstract
Concurrent rupture of hepatic hydatid cysts into the biliary tree and into the pleural cavity is a very rare complication in echinococcosis and can pose diagnostic and treatment challenges. We present the case of a 15-year-old female patient with recurrent abdominal pain, chest pain, fever, vomiting, jaundice, and cholangitis. Ultrasound, X-rays, computed tomography of the abdomen and thorax and cholangio-magnetic resonance imaging revealed a hepatic hydatid cyst with rupture into the main biliary duct causing obstruction, gallbladder microlithiasis, rupture of the right hemidiaphragm, and pleural hydatidosis. Echinococcus serology tests were positive. Endoscopic retrograde cholangiopancreatography (ERCP) could not resolve the obstructive jaundice. A laparotomy with choledochotomy, removal of hydatid structures, choledochal drainage with Kehr tube, cholecystectomy, Lagrot partial pericystectomy, partial pleural resection, suturing of the diaphragm, and triple drainage (right pleural cavity, cystic cavity, and Douglas pouch) was performed. Perioperative albendazole and antibiotic therapy was administered. The patient had an uneventful postoperative course. Follow-up at 1, 6, 12, and 24 months showed a favorable evolution without relapse of the hydatidosis. The very rare complications of cholangiohydatidosis and concomitant hepatothoracic transit lead to a severe condition, which needs adequate surgical treatment. Clinical presentation and laboratory findings are not specific and may simulate an obstructive jaundice and acute cholangitis of other etiology. ERCP with endoscopic papillotomy offers the advantage of a minimally invasive surgery, but it does not allow a definitive treatment of the whole problem and may be useful as a bridge procedure to drain the bile duct while awaiting definitive surgery.
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Affiliation(s)
- Narcis Flavius Tepeneu
- Department of Pediatric Surgery and Orthopaedics, University of Medicine and Pharmacy “V. Babes”, Timisoara, Timisoara, Romania
- Department of Children's and Adolescent Surgery, Hospital Klagenfurt Am Wörthersee, Klagenfurt Am Wörthersee, Austria
- Pediatric Surgery and Orthopaedics Clinic, “L. Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Călin Marius Popoiu
- Department of Pediatric Surgery and Orthopaedics, University of Medicine and Pharmacy “V. Babes”, Timisoara, Timisoara, Romania
- Pediatric Surgery and Orthopaedics Clinic, “L. Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery and Orthopaedics, University of Medicine and Pharmacy “V. Babes”, Timisoara, Timisoara, Romania
- Pediatric Surgery and Orthopaedics Clinic, “L. Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Simona Cerbu
- Department of Pediatric Surgery and Orthopaedics, University of Medicine and Pharmacy “V. Babes”, Timisoara, Timisoara, Romania
- Pediatric Surgery and Orthopaedics Clinic, “L. Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Oana Belei
- Department of Pediatric Surgery and Orthopaedics, University of Medicine and Pharmacy “V. Babes”, Timisoara, Timisoara, Romania
- Pediatric Surgery and Orthopaedics Clinic, “L. Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Rodica Heredea
- Department of Pediatric Surgery and Orthopaedics, University of Medicine and Pharmacy “V. Babes”, Timisoara, Timisoara, Romania
- Pediatric Surgery and Orthopaedics Clinic, “L. Turcanu” Emergency Children's Hospital, Timisoara, Romania
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Aziz TM, Ali CM, Maissa J, Ibtissem K, Faouzi N. Hydatid cyst of the pancreas revealed by acute pancreatitis: A case report. Int J Surg Case Rep 2024; 124:110383. [PMID: 39393296 PMCID: PMC11562394 DOI: 10.1016/j.ijscr.2024.110383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 09/24/2024] [Accepted: 09/28/2024] [Indexed: 10/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE A hydatid cyst is a parasitic disease caused by the development of the larval form of Echinococcus granulosus (1). The liver and lungs are the most frequent locations, while pancreatic involvement is unusual (<1 %), even in countries where hydatid disease is endemic (2). We report a rare case of a hydatid cyst of the pancreas, revealed by acute pancreatitis. Through this observation and a review of the literature, we discuss the diagnostic and therapeutic challenges of this rare localization of a hydatid cyst. CASE PRESENTATION A 60-year-old man from rural southwestern Tunisia, with a medical history of cardiac conduction disorder such as atrioventricular block treated with a pacemaker and type II diabetes for 10 years, presented with epigastric pain and periodic episodes of vomiting for the past 2 years. The patient noticed a recent exacerbation of the pain over the last 3 months. On physical examination, there was no jaundice or fever. Mild tenderness of the entire supramesocolic region of the abdomen was revealed, and no palpable mass was evident. Biological tests showed an elevation of lipase to 5 times the normal level and an increased leukocyte count of 12,000/dL. Liver function tests were normal. The CT scan indicated pancreatitis, Balthazar grade E, with cystic formation in the tail of the pancreas extending into the dilated Wirsung duct. The echinococcal immunological test (ELISA) was positive, and tumor markers (CEA, CA 19-9) were negative. The diagnosis of a pancreatic hydatid cyst with pancreatitis was considered. The patient underwent surgery 2 months after the onset of pancreatitis. A left splenopancreatectomy was performed. Histopathological examination confirmed the presence of a hydatid cyst. Following an uneventful postoperative period, the patient was discharged on the 7th postoperative day. The patient was treated with Penicillin V (Oracillin®) 2 million IU per day for 2 years and Albendazole 800 mg per day for 2 months after surgery. At 1 year post-surgery, no hydatid recurrence was detected, and hydatid serology was negative. CLINICAL DISCUSSION Finally, We reported the case of a rare observation of hydatid cyst of the pancreas revealed by acute pancreatitis. CONCLUSION We highlighted the necessity to consider the hydatid origin when evaluating complicated cystic pancreatic tumors, especially in endemic regions.
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Affiliation(s)
- Touzi Mohamed Aziz
- Digestive Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
| | - Chaouech Mohamed Ali
- Digestive Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Jalleli Maissa
- Digestive Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Korbi Ibtissem
- Digestive Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Noomen Faouzi
- Digestive Surgery Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Chaouch MA, Taieb AH, Gafsi B, Zayati M, Gaied S, Noomen F. Misleading Mercedes-Benz sign: A case report of misdiagnosed cholecysto-hydatid cyst fistula in acute cholecystitis. Int J Surg Case Rep 2024; 124:110416. [PMID: 39368304 PMCID: PMC11490726 DOI: 10.1016/j.ijscr.2024.110416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 10/02/2024] [Accepted: 10/03/2024] [Indexed: 10/07/2024] Open
Abstract
INTRODUCTION Liver hydatid cysts represent a significant health concern globally, particularly in endemic regions like Tunisia. While they often lead to complications such as biliary fistulas, diagnostic errors can arise from radiologic signs like the "Mercedes Benz sign," which indicates gas within the gallbladder. This report highlights the challenge of diagnosing a rare cholecysto-hydatid cyst fistula, where the presence of gas in the gallstones initially suggested a fistula. CASE PRESENTATION A 30-year-old female presented with right hypochondrium pain and fever. Ultrasound suggested cholecystitis and identified two cystic formations in liver segments IVb and VII. CT scan revealed intravesicular air bubbles, suggesting a cholecysto-hydatid fistula. Emergency surgery was performed. Intraoperatively, there was an acute cholecystitis. The liver hydatid cyst of segment IVb communicated with the biliary tree and there was no cholecysto-hydatid fistula. We performed a cholecystectomy, cholangiography, and a total pericystectomy for the two liver hydatid cysts. The postoperative follow-up was uneventful. DISCUSSION The "Mercedes Benz sign," often indicating gas within gallstones, is rare but can mislead the diagnosis toward a cholecysto-hydatid cyst fistula. This case highlights the diagnostic challenge posed by this radiological feature, which led to initial suspicion of a fistula. Hydatid cysts, though common in endemic regions, can lead to diagnostic dilemmas, especially when atypical signs are present. CONCLUSIONS The presence of gas in the gallbladder can mislead the diagnosis, particularly when the "Mercedes Benz sign" is present, as it may suggest a rare cholecysto-hydatid cyst fistula. However, this is not always the case. Prompt and accurate evaluation, including intraoperative findings, to reinforce clinical suspicion and decision-making in endemic regions.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia.
| | - Ahmed Hadj Taieb
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Besma Gafsi
- Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia
| | - Mohamed Zayati
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Sofien Gaied
- Department of Radiology, Monastir University Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
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Trigui A, Fendri S, Saumtally MS, Akrout A, Trabelsi J, Daoud R, Toumi N, Ketata S, Boujelbene W, Mzali R, Dziri C, Ben Amar M, Boujelben S. Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study. PLoS Negl Trop Dis 2024; 18:e0012289. [PMID: 38924053 PMCID: PMC11232992 DOI: 10.1371/journal.pntd.0012289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Surgery is the mainstay of hepatic cystic echinococcosis (HCE). The conservative surgery of HCE carries a non-negligible risk of recurrence and significant morbidity, dominated by Deep Surgical Site Infections (DSSI). To address these issues, we have improved and standardized this technique, which could reduce complications and achieve better postoperative outcomes. PATIENTS AND METHODS We conducted a prospective study from June 2017 to June 2022 involving of patient operated using a standardized open technique for uncomplicated HCE at Habib Bourguiba University Hospital, Sfax, Tunisia. The aim was to obtain results at least similar to radical management in terms of DSSI. Patients with large cystobiliary fistulas or patients with complicated cysts were excluded. RESULTS Fifty patients with 106 cysts were operated using the standardized technique comprising of liver mobilization, intraoperative ultrasound, systematic methylene blue injection to detect cystobiliary fistulas and omentoplasty. The median age of the patients was 44(semi-interquartile range: 16) years. The main symptom described by the patient was pain in 43 cases (86%). An abnormal liver test was found in 20 cases (40%). On imaging studies, the cyst had a median size of 7.4(3.0) cm. Cyst of the hepatic dome accounted for 38 cases (35.8%) with most cysts being situated in the right hemi-liver. Visual inspection of the cavity and Methylene blue testing allowed for the discovery of 57 cysts (53.7%) that had cystobiliary fistulas that were sutured. Omentoplasty was performed in 77 cysts (72.6%). Postoperatively, only 2 cases (1.9%) developed a DSSI in the form of an external bile leak with resolved with conservative management. No case of recurrence was found after a median follow-up of 24 months. CONCLUSION The standardized conservative surgical technique, in selected patients, shows promise in reducing DSSI rates and overall morbidity, and achieve as equally good result as radical management.
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Affiliation(s)
- Aymen Trigui
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Sami Fendri
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mohammad Saad Saumtally
- University of Sfax, Faculty of Medicine; Department of Epidemiology. Hédi Chaker Hospital, Sfax, Tunisia
| | - Amira Akrout
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jihen Trabelsi
- University of Sfax, Faculty of Medicine; Department of Epidemiology. Hédi Chaker Hospital, Sfax, Tunisia
| | - Rahma Daoud
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nozha Toumi
- University of Sfax, Faculty of Medicine; Department of Radiology. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salma Ketata
- University of Sfax, Faculty of Medicine; Department of Anaesthesiology. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Wael Boujelbene
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Rafik Mzali
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Chadli Dziri
- University of Tunis, General Surgery; Honoris Medical Simulation Centre director, Tunisia
| | - Mohamed Ben Amar
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salah Boujelben
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
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Trigui A, Khmekhem N, Fendri S, Daoud R, Akrout A, Trabelsi J, Mzali R, Cheikhrouhou F, Ayadi A, Dziri C, Amar MB, Boujelbene S. Viability predictive factors of the daughter vesicles in hepatic cystic echinococcosis. BMC Infect Dis 2024; 24:43. [PMID: 38172702 PMCID: PMC10765707 DOI: 10.1186/s12879-023-08937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Management of cystic echinococcosis (CE) requires knowledge of certain aspects related to the survival of Echinococcus granulosus. The viability of daughter vesicles (DV) is a determining factor in guiding therapeutic indications, particularly for transiently active Cysts type CE3b. PURPOSE To determine the predictive factors of DV viability and its impact on the therapeutic management of CE3b type. MATERIALS AND METHODS This is a prospective pilot study with an analytical aim on patients with cystic echinococcosis of the liver type CE2 and CE3b, operated in the General Surgery Department of Habib-Bourguiba Academic Hospital, Sfax-Tunisia for 22 months from March 2018 until December 2019. The unit of the study is the DV. A parasitological study of the DV was done in the parasitology laboratory. RESULTS During the study period, 27 (40.9%) of 66 operated CE Disease from 21 patients containing 248 DV were explored. The median viability of DV protoscoleces was 16.7%. In bivariate analysis, factors for viability of DV protoscoleces were: fever, acute cholangitis, hyperbilirubinemia, left liver location, rock water and bilious echinococcal fluid (EF), cyst size ≥ 43 mm, Intracystic pressure ≥ 35 mmHg, DV size ≥ 6.5 mm, volume, number of DV/cyst ≥ 5, and opaque wall (p < 0.05). Predictive factors for the Non-viability of DV were: CE3b type, purulent EF, gelatinous EF. In multivariate analysis, only CE2 type, cyst size ≥ 43 mm, number of DV/cyst ≥ 5 and DV size ≥ 6.5 mm were factors significantly associated with the viability of DV protoscoleces. CONCLUSION CE3b cysts without the criteria of viability of DV protoscoleces may become candidates for the 'Wait-and-Watch' procedure.
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Affiliation(s)
- Aymen Trigui
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia.
| | - Nahed Khmekhem
- Faculty of Medicine, Department of Parasitology and Mycology, University of Sfax, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Sami Fendri
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia
| | - Rahma Daoud
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia
| | - Amira Akrout
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia
| | - Jihene Trabelsi
- Faculty of Medicine, Department of Epidemiology, University of Sfax, Hedi Cheker Hospital, Sfax, Tunisia
| | - Rafik Mzali
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia
| | - Fatma Cheikhrouhou
- Faculty of Medicine, Department of Parasitology and Mycology, University of Sfax, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Ali Ayadi
- Faculty of Medicine, Department of Parasitology and Mycology, University of Sfax, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Chadli Dziri
- General Surgery, Honoris Medical Simulation Center Director, Medical school of Tunis, University El Manar, Tunis, Tunisia
| | - Mohamed Ben Amar
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia
| | - Saleh Boujelbene
- Faculty of Medicine, Department of General and Digestive Surgery, University of Sfax, Habib Bourguiba Hospital, Sfax, 3029, Tunisia
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Alsaadawi MA, Al-Safar AHA, Khudhur HR, Abd SM, Hussein HM, Allawi AH, Ali MJ. Histopathological and immunological study of rats liver hydatid cysts isolated from human, sheep, goat and cows. J Parasit Dis 2022; 46:952-966. [PMID: 36457784 PMCID: PMC9606169 DOI: 10.1007/s12639-022-01512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
In endemic places, liver hydatidosis is a life-threatening health issue. Many consequences such as hepatomegaly, infiltration with inflammatory cells and histopathological changes might arise as a result of liver hydatidosis. This study aimed to look into pathogenic changes in the livers of the rats that experimentally infected with hydatid cysts. These hydatid cysts were isolated from naturally infected humans, sheep, goats and cows. Liver hydatid cysts were collected from the main abattoir of Al-Muthanna province while human hydatid cysts were collected from Al-Hussein Teaching Hospital in Al-Muthanna province. The hydatid cysts were grossly and histology examined for inspection of hydatid cysts. The in vivo experiments were done by injection of hydatid protoscoleces or sand (fluid) in rats intraperitoneally. The results showed that the gross signs were same in all infected livers which range from paleness, hepatomegaly, hemorrhage and calcification. The hydatid cysts isolated from sheep and goat livers were highly fertile compared to others isolated from humans and cows. Injection of hydatid protoscoleces and hydatid fluid isolated from sheep and goat livers in rats induced the highest immune response compared to that isolated from humans and cows. The liver sections of rats that were injected with human, goat and sheep hydatid protoscoleces and fluids showed hyperplasia in the bile duct, aggregation nonnuclear cells with congested blood vessels. While liver sections of rats were received goat hydatid fluid, cow hydatid protoscoleces and hydatid fluid showed normal liver tissue. These findings suggested that the immunogenicity of hydatid materials is different according to the host and the component of hydatid cysts.
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Affiliation(s)
| | | | | | - Saif Mazeel Abd
- Department of Medical Laboratories, College of Medical and Health Techniques, Sawa University, Samawah, Iraq
| | | | | | - Mansour Jadaan Ali
- College of Veterinary Medicine/University of Al-Qadisiyah, Al Diwaniyah, Iraq
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Tawashi K, Tawashi Y, Naqoula S. A hydatid cyst in mesentery complicated with appendicitis in nine-year-old child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Öztürk G, Uzun MA, Özkan ÖF, Kayaalp C, Tatlı F, Eren S, Aksungur N, Çoker A, Bostancı EB, Öter V, Kaya E, Taşar P. Turkish HPB Surgery Association consensus report on hepatic cystic Echinococcosis (HCE). Turk J Surg 2022; 38:101-120. [PMID: 36483170 PMCID: PMC9714645 DOI: 10.47717/turkjsurg.2022.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cystic Echinococcosis (CE) is one of the important problems of the Eurasian region. We aimed to prepare a consensus report in order to update the treatment approaches of this disease. This study was conducted by Turkish HPB Surgery Association. MATERIAL AND METHODS This study was conducted with the modified Delphi model. For this purpose, we conducted a three-stage consensus-building approach. RESULTS Six topics, including diagnosis, medical treatment, percutaneous treatment, surgical treatment, management of complications and posttreatment follow-up and recurrences in HCE were discussed. CONCLUSION The expert panel made recommendations for every topic.
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Affiliation(s)
- Gürkan Öztürk
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Mehmet Ali Uzun
- Clinic of General Surgery, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Türkiye
| | - Ömer Faruk Özkan
- Clinic of General Surgery, Ümraniye Education and Research Hospital, İstanbul, Türkiye
| | - Cüneyt Kayaalp
- Department of General Surgery, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Faik Tatlı
- Department of General Surgery, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
| | - Suat Eren
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Nurhak Aksungur
- Department of General Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ahmet Çoker
- Clinic of General Surgery, Medicana International İzmir Hospital, İzmir, Türkiye
| | | | - Volkan Öter
- Clinic of Gastroenterological Surgery, Ankara State Hospital, Ankara, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Pınar Taşar
- Department of General Surgery, Uludağ University Faculty of Medicine, Bursa, Türkiye
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Ghannouchi M, Rodayna H, Ben Khalifa M, Nacef K, Boudokhan M. Postoperative morbidity risk factors after conservative surgery of hydatic cyst of the liver: a retrospective study of 151 hydatic cysts of the liver. BMC Surg 2022; 22:120. [PMID: 35351087 PMCID: PMC8966364 DOI: 10.1186/s12893-022-01570-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/14/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of the present paper is to assess the morbidity specifics risk factors of hepatic hydatid cyst after conservative surgery. METHODS We conducted a retrospective study of 102 patients over a period of 13 years, from 2006 to 2019. We included all patients operated on hydatid cyst of the liver, complicated and uncomplicated, in the Department of General Surgery in Tahar Sfar hospital, Mahdia, Tunisia. We excluded patients who received an exclusive medical treatment and those who have other hydatic cyst localizations. RESULTS The cohort was composed of 102 patients with a total of 151 cysts operated on using conservative surgery, among them there was 75 women (73.5%) and 27 men (26.5%). The median age was 43, with extremes ranging from 12 to 88 years. The majority of patients (94.1%) were from rural areas. The cysts were uncomplicated in about half of the cases (48%), elsewhere complications such as compression of neighboring organs (25.5%), opening in the bile ducts (16.7%), infection (9.8%), and rupture in the peritoneum (2%) were found. Conservative surgery was the mainstay of treatment with an overall mortality rate of 1.9%. The overall morbidity rate was 22%: 14% specific morbidity and 8% non-specific morbidity. External biliary fistula was the most common postoperative complication (9%). The predictive factors of morbidity in univariate analysis were: preoperative hydatid cyst infection (P = 0.01), Compressive cysts (P = 0.05), preoperative fever and jaundice, (respectively P = 0.03 and P = 0.02), no one achieved statistical significance in the multivariate model. CONCLUSIONS Preoperative hydatid cyst infection, compressive cysts and preoperative fever and jaundice could be predictor factors of morbidity after conservative surgery for liver hydatid cyst. They must be considered in the treatment and the surgical decision for patients with hydatid cyst.
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Affiliation(s)
- Mossaab Ghannouchi
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia.
| | - Hawas Rodayna
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Mohamed Ben Khalifa
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Karim Nacef
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Moez Boudokhan
- Department of General Surgery, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
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Pelvic Hydatid Cyst with Hydroureteronephrosis: A Rare Case Report. Case Rep Infect Dis 2022; 2021:2090849. [PMID: 34992888 PMCID: PMC8727127 DOI: 10.1155/2021/2090849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Hydatid cyst is a parasitic disease caused by Echinococcus granulosus or Echinococcus multilocularis. Humans are accidentally infected with the parasite. The cyst is usually found in the liver and lungs and rarely occurs in other body parts. The present article describes a rare case of pelvic hydatid cyst in a young man who presented with nausea, vomiting, and right abdominal pain. Two large cystic masses were discovered during a CT scan in the patient's pelvic region, resulting in right urinary tract hydroureteronephrosis. Additionally, the antibody index was used to confirm the presence of a primary hydatid cyst.
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Tamarozzi F, Manciulli T, Brunetti E, Vuitton DA. Echinococcosis. HELMINTH INFECTIONS AND THEIR IMPACT ON GLOBAL PUBLIC HEALTH 2022:257-312. [DOI: 10.1007/978-3-031-00303-5_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Khaled C, Kachi A. Trauma-Induced Rupture of Liver Hydatid Cyst: A Rare Cause of Anaphylactic Shock. Surg J (N Y) 2021; 7:e347-e350. [PMID: 34966847 PMCID: PMC8702299 DOI: 10.1055/s-0041-1740624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Hydatid disease is rare; nevertheless, several areas of the world are endemic. Lebanon is one of the endemic countries. This disease requires careful management, as its diagnosis is tough, and its complications are severe and can lead to sudden death. These complications include fistulas, infection, and rupture. Rupture of a hydatid cyst can mimic acute abdomen and show an array of nonspecific symptoms. It could be mistaken for hemorrhagic shock, trauma, or injury to an intra-abdominal organ. The diagnosis of ruptured hydatid cyst should be kept in mind in cattle-raising countries. We report the case of a polytrauma patient who was suspected to have severe intra-abdominal bleeding and hemorrhagic shock, but imaging and laparotomy showed the rupture of a liver hydatid cyst that drove the patient into anaphylactic shock. This article reviews similar cases in the literature and discusses the diagnostic tools, appropriate management, and expected complications.
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Affiliation(s)
- Charif Khaled
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Antoine Kachi
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.,Department of General Surgery, University Medical Center, Lebanese Hospital Geitaoui, Beirut, Lebanon
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Christodoulidis G, Samara AA, Diamantis A, Floros T, Sgantzou IK, Karakantas KS, Zotos PA, Koutras A, Janho MB, Tepetes K. Reaching the Challenging Diagnosis of Complicated Liver Hydatid Disease: A Single Institution's Experience from an Endemic Area. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1210. [PMID: 34833428 PMCID: PMC8620203 DOI: 10.3390/medicina57111210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/25/2022]
Abstract
Background and Objectives: Hydatid disease (HD) remains a significant public health issue causing morbidity and mortality in many Mediterranean countries. Material and Methods: The present cohort study included 50 consecutive patients with liver hydatid disease who underwent surgery in a tertiary University Hospital. A total of 18 patients (36%) had a case of complicated HD, including simple communication of the cyst with the biliary tree (6 cases), rupture of the cyst into the biliary tree (6 cases), presence of a bronco-biliary fistula (2 cases), rupture of the cyst in the peritoneal cavity (2 cases), and rupture of the cyst and formation of a hepatic abscess (2 cases). Endoscopic retrograde cholangiopancreatography (ERCP) was pre-operatively performed on six patients. Results: The main clinical symptom presented was right upper quadrant pain in 16 patients (88%), which was associated with high fever (>39 °C) in 14 patients (78%). C-reactive protein (CRP) was the primary indicator of a complicated HD (p = 0.003); however, it was only elevated in 67% of cases. CRP was a more sensitive indicator of a rupture in the biliary tree cyst (p = 0.02). Computer tomography (CT) detected more cases (44%) of a complicated HD than ultrasonography (US) (25%); however, the difference was not statistically significant. Conclusions: For prevention and control of HD, a high suspicion of the disease leading to early referral to specialized centers, mainly in endemic areas, is required. Prior to surgical or percutaneous intervention, a combination of imaging and laboratory findings are essential in diagnosing a complicated case and avoiding unnecessary interventions.
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Affiliation(s)
| | - Athina A. Samara
- Department of General Surgery, General University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece; (G.C.); (A.D.); (T.F.); (I.-K.S.); (K.-S.K.); (P.-A.Z.); (A.K.); (M.B.J.); (K.T.)
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Regmee S, Maharjan DK, Thapa PB. The Current Protocols in the Management of Hepatic Hydatid Disease. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02724-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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18
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Khuroo MS. Percutaneous Drainage in Hepatic Hydatidosis-The PAIR Technique: Concept, Technique, and Results. J Clin Exp Hepatol 2021; 11:592-602. [PMID: 34511821 PMCID: PMC8414317 DOI: 10.1016/j.jceh.2021.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
Over decades, surgery has been the only accepted mode of treatment for liver hydatid cysts. It had been a surgical dogma for a long that hydatid disease is an absolute contraindication for needle puncture/aspiration as it can cause anaphylaxis, death, and dissemination. We envisaged prospectively perform percutaneous drainage as a primary form of treatment for hepatic hydatidosis. Through extensive and very careful experimentation, we proved that aspiration of hydatid cysts can be performed safely and is the ideal way to manage a subset of patients with hydatid cysts in the liver. The patient and cyst characteristics good and not good for percutaneous drainage were carefully selected. The procedure of percutaneous drainage of hepatic hydatid cysts involves four sequential steps as defined in the alphabets of the title PAIR, denoting puncture (P), Aspiration (A), Instillation (I), and Reaspiration (R). During and postprocedure, we enforced strict monitoring given the anticipated anaphylaxis. The first PAIR procedure was performed in June 1988. The results of percutaneous drainage of 21 cysts in 12 patients were reported in 1991. Next, a prospective study was done to show that concomitant Albendazole therapy is recommended as an adjuvant to percutaneous drainage for hepatic hydatidosis. In a seminal prospective study comparing percutaneous drainage and surgery, we showed that percutaneous drainage is as good as surgery in the management of uncomplicated hydatid cysts with fewer complications and shorter hospital stays. Lastly, long-term follow-up results of percutaneous drainage on a large cohort of patients with hepatic hydatid cysts were reported, with excellent results and no evidence of local, peritoneal or systemic dissemination. Based on these data percutaneous drainage, the so-called PAIR technique has established itself as a novel therapeutic advance in hepatic hydatid disease.
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Affiliation(s)
- Mohammad S. Khuroo
- Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Digestive Diseases Centre, Dr. Khuroo’s Medical Clinic, Srinagar, Kashmir, India
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Omentoplasty decreases deep organ space surgical site infection compared with external tube drainage after conservative surgery for hepatic cystic echinococcosis: Meta-analysis with a meta-regression. J Visc Surg 2021; 159:89-97. [PMID: 33771491 DOI: 10.1016/j.jviscsurg.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The rate of deep organ space/surgical site infection after conservative surgery for hepatic cystic echinococcosis (HCE) ranges from 12% to 26% with a post-operative mortality rate between 0% and 7.5%. This systematic review with meta-analysis aimed to investigate whether omentoplasty (OP) following conservative surgery for HCE leads to decreased rates of morbidity and mortality compared to external tube drainage ETD. PATIENTS AND METHODS We identified 4540 articles through database searching. After verifying the inclusion and exclusion criteria, we retained eight studies for final analysis: two randomized controlled trials (RCT), one prospective comparative study and five retrospective comparative studies. The main outcome measure was organ space/surgical site (OS/SS) morbidity that was limited to "deep organ space/surgical site infection (Deep OS/SSI) with or without re-operation". RESULTS The eight studies reported results for deep OS/SSI (6/374 (OP) and 60/403 (ETD), respectively). There were statistically significantly less deep OS/SSI with OP (vs. ETD) OR=0.17 95%CI [0.05, 0.62] (P=0.007). A random-effect meta-regression, including the eight studies, showed an interaction in favor of OP. There were also statistically significant less biliary leakage±fistula and overall morbidity in OP compared to ETD. On the other hand, no statistically significant difference was found concerning deep bleeding, mortality and recurrence between these two groups. CONCLUSION This meta-analysis with a meta-regression showed that there were statistically significant less deep OS/SSI, biliary leakage±fistula and overall morbidity in OP compared to ETD.
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20
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Hosseini Shabanan S, Dashti SH, Abbasi M, Jafarian A, Ebrahimi A, Ayoobi Yazdi N. Retrospective Review of Complications of Liver Hydatid Cyst Surgery with Emphasis on Outcomes of Omentoplasty. IRANIAN JOURNAL OF PARASITOLOGY 2020; 15:488-494. [PMID: 33884005 PMCID: PMC8039479 DOI: 10.18502/ijpa.v15i4.4853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The outcome and complications of liver hydatid cyst surgeries with new and old techniques are not well determined. We intended to present the results of operations done for patients with hepatic hydatid cyst in an endemic area. Methods Data of 112 patients referred and operated for liver hydatid cyst, in Imam Khomeini Hospital complex, Tehran, Iran, from 2015 to 2018, were collected including demographic characteristics, operation parameters and complication related statistics. The variables were presented for different surgical methods including operations with and without omentoplasty. Results Patients aged 39. 3 ± 13. 9 yr (70 females; 63. 5%). Most frequent clinical complaint was vague abdominal pain (n=45; 40. 2%). The most prevalent comorbidity was hypertension (18; 16.0%). Conservative methods were chosen more frequently including omentoplasty (44; 39. 3%), cyst drainage (27; 24. 1%), cyst resection (19; 17%) and marsupialization (3; 2. 7%). Overall, 56 patients (50%) were operated with omentoplasty as the single method or in combination with segmentectomy. Complications occurred less in patients operated with omentoplasty (41. 1 vs. 23. 2%; P=0. 043); particularly, biloma was more frequent in surgeries without omentoplasty (7. 1 vs 0. 0%; P=0. 042). Persistence and recurrence rates were 12. 5% and 3. 6% with relative predilection in, respectively, segmentectomy and lobectomy surgical methods compared to Omentoplasty. No mortality was recorded. Conclusions In our case series of hepatic hydatid cyst patients, omentoplasty was safe with less complication and similar long-term recurrence rate.
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Affiliation(s)
- Sedighe Hosseini Shabanan
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Habibollah Dashti
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirpasha Ebrahimi
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ayoobi Yazdi
- Advanced Diagnostic and Interventional Radiology (ADIR) Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Singh S, Kalra G, Gupta V, Gupta S. Primary Giant Hydatid Cyst of Lumbar Paraspinal Muscles. World Neurosurg 2020; 141:240-244. [PMID: 32540285 DOI: 10.1016/j.wneu.2020.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hydatid cyst disease, commonly caused by Echinococcus granulosus, rarely occurs in paraspinal muscles. Among the few reported cases, the current case is the largest paraspinal hydatid cyst disease ever reported in literature with a review of management of such large lesions. CASE DESCRIPTION A 38-year-old male presented with lower back swelling for 1 year. Ultrasonography and magnetic resonance imaging scans suggested hydatidosis, following which the patient was taken up for surgery after preoperative medical therapy. En bloc resection was done, and histopathologic examination of the resected specimen confirmed the diagnosis. Postoperative albendazole was also used, and no recurrence was noted at 24 months post operation. CONCLUSIONS Hydatid disease should be kept as one of the differential diagnoses for back swelling, especially in endemic regions. Giant-sized hydatid cysts of paraspinal muscles, though rare, cannot be ruled out on clinical ground alone. Thorough history taking and detailed examination should be aided with radiologic investigations like magnetic resonance imaging for an accurate diagnosis. En bloc excision of the cyst combined with preoperative and postoperative medical therapy is an effective method of treating this condition and significantly reducing complication rates.
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Affiliation(s)
- Sudeep Singh
- Department of Neurosurgery, Government Medical College & Hospital, Chandigarh, India
| | - Gagan Kalra
- Department of Neurosurgery, Government Medical College & Hospital, Chandigarh, India
| | - Vipin Gupta
- Department of Neurosurgery, Government Medical College & Hospital, Chandigarh, India.
| | - Soumya Gupta
- Department of Neurosurgery, Government Medical College & Hospital, Chandigarh, India
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22
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Ramia Ángel JM, Manuel Vázquez A, Gijón Román C, Latorre Fragua R, de la Plaza Llamas R. Radical surgery in hepatic hydatidosis: analysis of results in an endemic area. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:708-711. [PMID: 32496115 DOI: 10.17235/reed.2020.6722/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION radical surgery in hepatic hydatidosis is associated with less morbidity and recurrence than conservative surgery. MATERIAL AND METHODS a retrospective observational study of patients with liver hydatid cyst surgery was performed. Seventy-one patients with 90 cysts were included between 2007 and 2017, and radical surgery was performed in 69.01 %. RESULTS there was no difference in morbidity, mortality, biliary leakage or recurrence according to surgery. Complicated cysts were associated with a longer hospital stay and morbidity. CONCLUSION decision-making should consider age, comorbidity, cyst characteristics and available resources. Radical surgery should be applied whenever feasible as it achieves better results with an adequate selection of patients.
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Multiple Hepatic and Renal Hydatid Cysts Managed with Laparoscopic Surgery. Case Rep Surg 2020; 2019:6969232. [PMID: 31934486 PMCID: PMC6942758 DOI: 10.1155/2019/6969232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 10/09/2019] [Accepted: 11/16/2019] [Indexed: 11/29/2022] Open
Abstract
Cystic echinococcosis is a parasitic disease caused by Echinococcus granulosus. The liver and lungs are the most commonly infected organs. We present the first-of-a-kind case of laparoscopic excision of 8 hydatid cysts, of which seven were in the liver and one was in the kidney of a 40-year-old patient. The patient presented with fatigue and fever and a one-year history of vague abdominal pain. Albendazole was administered before surgical intervention. The postoperative follow-up period was notable for a renal fistula. The patient subsequently underwent CT-guided percutaneous removal of a central hepatic hydatid cyst that was inaccessible using laparoscopic techniques. Cystic echinococcosis is endemic in the Mediterranean region. The growing number of immigrants and refugees from endemic areas could increase the prevalence of the disease in nonendemic countries. Therefore, it is important for physicians worldwide to be familiar with the diagnostic modalities and possible treatment options for hydatid disease.
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Dulundu E. Management of Hepatic Echinococcal Disease and Its Complications. THE SURGICAL MANAGEMENT OF PARASITIC DISEASES 2020:129-141. [DOI: 10.1007/978-3-030-47948-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Shaheen HAAAS, El-Ahl SAHS, Raouf AMA, El-Dardiry MA, Badawi MA, Aal AAA. Ultrastructural changes in hydatid cyst walls obtained from human cases, exposed to different therapeutic approaches. Parasitol Res 2019; 118:3149-3157. [PMID: 31578608 DOI: 10.1007/s00436-019-06446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
Recurrence of cystic echinococcosis as a result of treatment failure is frequently reported to cause a major problem in management of such serious parasitic infection. The deeply seated innermost germinal layer of hydatid cysts is a relatively delicate layer, yet responsible for viability maintenance of this parasitic stage. In this study, a trial was done to explore the ultrastructural changes in germinal and laminated layer of the hydatid cyst for the first time in human cases exposed to different therapeutic approaches which were done earlier to the final open surgical intervention. Four groups were included: group 1 did not receive any earlier form of treatment; group 2 was previously treated with only medical therapy; group 3 was treated with a single course of medical treatment, plus a single PAIR technique; group 4 was treated with multiple courses of medical treatment plus multiple PAIR techniques. Complete alteration of ultrastructural features of germinal and laminated layers were observed only with samples from group 4, indicating a kind of failure of the therapeutic approaches used in group, 1, 2, and 3, unless repeated in group 4 to achieve a real change regarding the fitness of the parasitic cystic lesions. Searching for more effective, safe, therapeutic method is highly recommended which may end the suffering of the affected patients.
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Affiliation(s)
| | | | - Amr Mahmoud Abdel Raouf
- Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Marwa Ahmed El-Dardiry
- Department of Medical Parasitology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | - Manal A Badawi
- Department of Pathology, National Research Institute, Giza, Egypt
| | - Amany Ahmed Abdel Aal
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Giza, Egypt.,Department of Medical Parasitology, Armed Forces College of Medicine (AFCM), Cairo, Egypt
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Simultaneous Hydatid Cyst of the Liver and Left Iliac Fossa: An Unusual Case Report. Case Rep Surg 2019; 2019:9101425. [PMID: 31565460 PMCID: PMC6745177 DOI: 10.1155/2019/9101425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/27/2019] [Indexed: 12/28/2022] Open
Abstract
Hydatid disease is a significant health problem in many livestock-rearing areas especially in the developing world, mainly caused by Echinococcus granulosus. The liver and lung are the most common affected sites. However, hydatid disease can occur anywhere in the body. Simultaneous involvement of two organs or sites is very unusual, mainly for organs other than the lung and liver. We thus report a very unusual combination of hepatic and left iliac fossa with hydatid disease in an adult patient. A 37-year-old farmer from a village presented with intermittent right upper quadrant and left iliac fossa pain associated with distention of abdomen for one month. Abdominal radiological investigations reported hydatid cyst disease; one cyst was found in the right lobe of the liver and another in the left iliac fossa. Positive IgG antibody by the ELISA test also confirmed the diagnosis. Pericystectomy and excision of hydatid cyst without spillage of content for the liver and left iliac fossa were done, respectively. Patient was discharged on the 10th postoperative day with an uneventful postoperative course. There was no recurrence of the lesion during one-year follow-up period. A combination of hydatid disease in the liver and iliac fossa is very unusual, so clinician should have thoughts regarding this rare entity as an important differential diagnosis.
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Mohammed AA, Arif SH. Surgical excision of a giant pedunculated hydatid cyst of the liver. J Surg Case Rep 2019; 2019:rjz208. [PMID: 31360435 PMCID: PMC6649717 DOI: 10.1093/jscr/rjz208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/12/2019] [Indexed: 12/23/2022] Open
Abstract
Hydatid disease is caused by a tape worm Echinococcus Granulosus that lives in the intestines of the definitive host which is the dog or other carnivore. Human is the accidental intermediate host and become infected by ingesting contaminated vegetables or water with the eggs of the parasite. A-37-year old male presented with right side abdominal pain for 2 months. Abdominal examination showed a large right side abdominal mass extending from the right subcostal region to the right iliac fossa. CT-scan showed two cystic lesions in the right lobe of the and a third one extending to the pelvis. During surgery aspiration of 10 liters of bile stained fluid done. Excision of the cysts done. Tube drain put inside the cyst cavity with omentoplasty. There was bile leak to the drain which stopped over one month. The patient received anthelminthic medication for 3 months.
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Affiliation(s)
- Ayad Ahmad Mohammed
- Department of Surgery, University of Duhok, College of Medicine, DUHOK, Kurdistan Region, Iraq
| | - Sardar Hassan Arif
- Department of Surgery, University of Duhok, College of Medicine, DUHOK, Kurdistan Region, Iraq
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Bayrak M, Altıntas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg 2019; 19:95. [PMID: 31315619 PMCID: PMC6637587 DOI: 10.1186/s12893-019-0553-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Background Liver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts. Methods All consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively. Results A total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age(p = 0.344), gender(p = 0.318), ASA classification(p = 0.963), Gharbi classification(p = 0.649) whereas there were significant differences related to cyst location(p = 0.040) and size(p = 0.022) in patients undergoing laparoscopic and open surgery. Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures. Conclusion Compared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.
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Affiliation(s)
- Mehmet Bayrak
- Department of General Surgery , Ozel Ortadogu Hospital, Ziyapasa Mahallesi 67055 Sokak no:1, Adana, Turkey.
| | - Yasemin Altıntas
- Department of Radiology , Ozel Ortadogu Hospital, 01360, Adana, Turkey
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Sudden death and hydatid cyst: A medicolegal study. Leg Med (Tokyo) 2019; 40:17-21. [PMID: 31299424 DOI: 10.1016/j.legalmed.2019.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022]
Abstract
The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.
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Imam A, Khoury T, Weis D, Khalayleh H, Adeleh M, Khalaileh A. Laparoscopic cystectomy for pancreatic echinococcosis: A case report and literature review. Ann Hepatobiliary Pancreat Surg 2019; 23:87-90. [PMID: 30863816 PMCID: PMC6405372 DOI: 10.14701/ahbps.2019.23.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/21/2018] [Accepted: 07/26/2018] [Indexed: 01/17/2023] Open
Abstract
Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with the Echinococcus granulosus tapeworm. Following ingestion of eggs, hydatid cysts develop, most frequently in the liver and lungs, but occasionally in other organs. Infection of the pancreas by hydatid cysts is very rare, even in endemic areas. Most cases of pancreatic hydatid cysts reported in the literature were treated surgically using traditional open laparotomy. There are only few case reports describing laparoscopic treatment for this disease. Herein, we report on an eighteen-year-old female patient who was referred to our institution with a hydated pancreatic tail cyst. After a course of treatment with Albendazole, we successfully performed laparoscopic splenic-sparing distal pancreatectomy to remove the cyst with an uneventful intra- and post-operative course.
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Affiliation(s)
- Ashraf Imam
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Tawfik Khoury
- Department of Gastroenterology and Liver Diseases, Jerusalem, Israel
| | - Dani Weis
- Department of Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Harbi Khalayleh
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Muhammad Adeleh
- Department of Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Abed Khalaileh
- Department of Surgery, Hadassah Medical Center, Jerusalem, Israel
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Muralidhar V, Santhaseelan RG, Ahmed M, Shanmuga P. Simultaneous occurrence of hepatic hydatid cyst and mucinous cystadenoma of the liver in a middle-aged female patient: report of a rare case. BMJ Case Rep 2018; 2018:bcr-2018-226077. [PMID: 30173135 DOI: 10.1136/bcr-2018-226077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We present a rare case of simultaneous occurrence of mucinous cystadenoma of the liver (MCN-L) and a hepatic hydatid cyst (HD-L) in a middle-aged female patient. This is the first case report of a common disease (HD-L) and a rare condition (MCN-H) occurring concurrently. MCN-H of the left lobe was inadequately resected in a rural centre leading to recurrence. She presented with a large upper abdominal lump and upper gastrointestinal symptoms. Radiological investigations and an ultrasound revealed a multilobulated cyst involving both lobes of the liver. There was no ascites. Liver function, basic haematology and renal function were normal. The recurrent MCN-L was removed totally. There was no communication between the MCN-L and the right lobe cyst, which turned out to be a hydatid cyst. The hydatid cyst was evacuated. She was discharged on albendazole and is asymptomatic with no recurrence at 8 months.
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Affiliation(s)
| | - R G Santhaseelan
- General Surgery, Sree Balaji Medical College and Hospital, Chennai, India
| | - Muzamil Ahmed
- General Surgery, Sree Balaji Medical College and Hospital, Chennai, India
| | - Prakash Shanmuga
- General Surgery, Sree Balaji Medical College and Hospital, Chennai, India
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Saidi F, Habibzadeh F. The Non-operative Management of Asymptomatic Liver Hydatids: Ending Echinococcophobia. J Gastrointest Surg 2018; 22:486-495. [PMID: 29119531 DOI: 10.1007/s11605-017-3630-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cystic echinococcosis is common in many countries and involves the liver in 75% of cases. The current belief is that all incidentally discovered asymptomatic liver hydatids must be subjected to some types of interventional treatments pre-emptively for fear of some presumably impending complications. We conducted this study to assess the prognosis of patients with liver hydatids without any surgical interventions. Furthermore, we tried to predict the outcome of the cyst using two radiological signs. METHODS Of 434 asymptomatic patients with liver cysts who referred to our center, 297 were found eligible to be monitored at 1-3-year intervals by unenhanced computed tomography (CT) over a 20-year period. The patients were given the option of either having their cysts removed by open operation (the surgical group) or entering an open-ended "watch-and-wait" program (the surveillance group). Using unenhanced CT, cyst size, laminated membrane detachment (LMD), and pericyst degenerative changes (PDCs) were evaluated every 1-3 years. If a complication happened or the cyst size increased during the follow-up period, the cyst outcome was considered "unfavorable"; otherwise, it was considered "favorable." RESULTS Forty-three patients with 56 liver cysts were operated upon without morbidity or mortality. One hundred and twenty-seven patients with 137 cysts were followed. After a median follow-up of 6 (IQR 3 to 10) years, 111 (81.0%) had favorable outcome and 26 (19.0%) cysts had an unfavorable outcome. The size of 69 (50.4%) cysts with favorable outcome was not changed. It was decreased by a mean of 35.7% (SD 17.5%) in 34 (24.8%) cysts; 8 (5.8%) cysts disappeared. Of 26 cysts with unfavorable outcome, 8 (5.8%) developed complications (6 fistulas and 2 secondary infections) after a median follow-up of 6.5 (IQR 2.3 to 12.8) years. The size of the remaining 18 cysts increased by a mean of 42.2% (SD 29.5%). Albendazole administered at a dose of 400 mg, po, bid for 3 years, had a significant effect on hydatids. After adjustment for cyst size at diagnosis and patient's age and sex, logistic regression analysis showed that being univesicular (OR 6.00, 95% CI 1.32 to 27.29), having LMD (OR 5.51, 95% CI 1.03 to 29.43), and the presence of PDCs (OR 4.25, 95% CI 1.36 to 13.30) were independent predictors of a favorable outcome for a cyst. CONCLUSIONS More than 80% of asymptomatic liver hydatids have a favorable outcome without pre-emptive surgical interventions. The presence of LMD at any stage and/or PDCs of any grade justifiably exempts asymptomatic univesicular liver hydatids from any treatments. Those without LMD or PDCs can be effectively managed with long-term albendazole, artificially inducing larval involution.
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Affiliation(s)
- Farrokh Saidi
- Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Farrokh Habibzadeh
- Shiraz University of Medical Sciences, Shiraz, Iran. .,R&D Headquarters, Petroleum Industry Health Organization, PO Box 71955-575, Shiraz, Iran.
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Dziri C, Dougaz W, Bouasker I. Surgery of the pancreatic cystic echinococcosis: systematic review. Transl Gastroenterol Hepatol 2017; 2:105. [PMID: 29354762 PMCID: PMC5763016 DOI: 10.21037/tgh.2017.11.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/24/2017] [Indexed: 12/16/2022] Open
Abstract
The prevalence of pancreatic cystic echinococcosis (PCE) in the world is low ranging between 0.2% and 0.6%. The diagnosis of PCE is easy when it is associated to other location such as liver, it became difficult when PCE was isolated simulating other diagnosis such as pseudocyst, a choledochal cyst, serous or mucinous cystadenoma and cystadenocarcinoma. This systematic review aimed to provide evidence-based answer to the following questions: (I) what are the efficient tools to affirm the diagnosis of isolated PCE and (II) what are the best therapeutic strategy for the PCE? An electronic search was performed by two authors (W Dougaz, I Bouasker). Medline, Scopus, Embase, Web of Science, Google Scholar and Cochrane collaboration were consulted. The keywords used were "cyst", "echinococcosis", "hydatid cyst" and "pancreas". All abstracts were analyzed followed by extraction of the full text by the same two authors (W Dougaz, I Bouasker), all divergences were resolved by discussion with C Dziri. Recommendations were based on Oxford's classification: (I) what are the efficient tools to affirm the diagnosis of PCE? -ultrasound remains the cornerstone of diagnosis. Magnetic resonance imaging (MRI) reproduces the ultrasound defined features of CE better than computed tomography (CT). MRI with heavily T2-weighted series is preferable to CT. Pancreatic duct MRI should be promising to identify a fistula between PCE and pancreatic duct (level of evidence 3-recommendation B); (II) what are the best therapeutic strategy for the PCE? -surgery is the main treatment of PCE. Open approach is validated. The decision depends of the location of PCE: head versus body and/or tail of the pancreas (level of evidence 5-recommendation D): for the head of the pancreas, the tendency is toward conservative surgery. For body and/or tail of the pancreas, the tendency is toward radical surgery. Medical treatment (albendazole) should be prescribed 1 week before surgery and 2 months during postoperative period (level II evidence and grade C recommendation).
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Affiliation(s)
- Chadli Dziri
- Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department B of General Surgery, Charles Nicolle’s Hospital, Tunis, Tunisia
| | - Wejih Dougaz
- Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department B of General Surgery, Charles Nicolle’s Hospital, Tunis, Tunisia
| | - Ibtissem Bouasker
- Medical School of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department B of General Surgery, Charles Nicolle’s Hospital, Tunis, Tunisia
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Pang Q, Jin H, Man Z, Wang Y, Yang S, Li Z, Lu Y, Liu H, Zhou L. Radical versus conservative surgical treatment of liver hydatid cysts: a meta-analysis. Front Med 2017; 12:350-359. [PMID: 29170917 DOI: 10.1007/s11684-017-0559-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/03/2017] [Indexed: 12/12/2022]
Abstract
To date, the efficacy of radical surgery (RS) versus conservative surgery (CS) for liver hydatid cysts (LHC) remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.
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Affiliation(s)
- Qing Pang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Hao Jin
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Zhongran Man
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yong Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Song Yang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Zongkuang Li
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Yimin Lu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Huichun Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
| | - Lei Zhou
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
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Paramythiotis D, Karakatsanis A, Bangeas P, Kofina K, Papadopoulos V, Apostolidis S, Michalopoulos A. Simultaneous Hepatic and Mesenteric Hydatid Disease-A Case Report. Front Surg 2017; 4:64. [PMID: 29209615 PMCID: PMC5702502 DOI: 10.3389/fsurg.2017.00064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Hydatid cysts most commonly present in the liver and the lungs; however, they can appear more rarely in other locations, such as the mesentery, with a rather unclear mechanism of manifestation. Herein, we present a case of simultaneous presence of hydatid cysts in the liver and the mesentery of a young man. CASE REPORT A 39-year-old man was referred to our Department for further investigation of intermittent abdominal pain, especially in the right upper quadrant, and abdominal distension. Abdominal CT imaging revealed three calcified lesions, one in the liver, a similar adjacent to an ileal loop and one close to the urinary bladder, while antibody control was positive for echinococcal infection. The lesions were excised and the patient was discharged on the seventh post-operative day in good general condition. Post-operative control after 6 months did not show any signs of recurrence. CONCLUSION Simultaneous presence of hydatid cysts in two organs occurs in 5-13% of cases. Presence in the mesentery is extremely rare, although, should be included in the classic differential diagnosis, especially in endemic areas.
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Affiliation(s)
- Daniel Paramythiotis
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Anestis Karakatsanis
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Petros Bangeas
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Konstantinia Kofina
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vassileios Papadopoulos
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Apostolidis
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propedeutic Surgical Department, A.H.E.P.A. University Hospital, Aristotle University Hospital of Thessaloniki, Thessaloniki, Greece
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Affiliation(s)
- Carlos Manterola
- Department of Surgery; Universidad de La Frontera; Temuco Chile
- Center of Morphological and Surgical Studies; Universidad de La Frontera; Temuco Chile
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Tatli F, Gozeneli O, yucel Y, Uzunköy A, Yalçın HC, Ozgönül A, Dirican A. Acute Abdomen Caused by Spontaneous Perforation of Hydatid Liver Cyst. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.339000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pacheco S, Galindo J, Bächler JP, Ahumada V, Rebolledo R, Crovari F, Briceño E, Guerra JF, Martínez J, Jarufe N. Resultados del tratamiento laparoscópico de los quistes hidatídicos hepáticos no complicados. REVISTA CHILENA DE CIRUGÍA 2017; 69:283-288. [DOI: 10.1016/j.rchic.2016.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Toumi O, Noomen F, Salem R, Rabeh H, Jabra SB, Korbi I, Bannani S, Nasr M, Zouari K, Mondher G, Hamdi A. Intraperitoneal rupture of hydatid cysts. Eur J Trauma Emerg Surg 2017; 43:387-391. [PMID: 27084544 DOI: 10.1007/s00068-016-0662-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 03/07/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Hydatid cyst rupture into abdominal cavity is a rare but a serious complication. The rupture can occur after a trauma, or spontaneously as a result of increased intracystic pressure. It is a surgical emergency with high morbidity and mortality rates. Early diagnosis and appropriate surgical management of this complication can be life saving. The objective of the current paper is to evaluate the clinical, and radiographic findings and surgical treatment of this complication. METHODS A retrospective study on 12 patients operated in our department for intraperitoneal rupture of hydatid cyst between January 1990 and May 2015. We reviewed age, gender, imaging findings, surgical treatment procedures, mortality, morbidity and recurrence. RESULTS Our study includes 12 cases of intraperitoneal rupture of hydatid cysts; eight of the patients were men, and four were women. Four patients had a history of abdominal trauma and the other ruptures occurred spontaneously. All the patients had peritoneal irritation signs at presentation. All them underwent ultrasonography and CT scan. Imaging showed intraabdominal free fluid in all of cases. In 11 cases the cyst was unique and only in one case an associated mesenteric hydatid cyst was noted. Ruptured cysts were located in the right lobe of the liver in nine cases, in the left lobe in the other three cases. All the patients underwent emergency surgery after imaging. The procedure applied was conservative associated with drainage in all the cases. Some associated procedures were performed during the same operation. In only one case total pericystectomy for intraperitoneal cyst was performed. There were no post operative deaths. A total of five morbidities developed in three patients (one case of evisceration, three cases of biliary fistula and a case of pulmonary infection). CONCLUSIONS Hydatid cyst rupture in peritoneal cavity is a rare complication. Imaging assessment has an important role in diagnosis but clinical signs are mandatory. A quick diagnosis and emergency surgery can decrease postoperative death. Surgery and postoperative care constitute the basis of treatment.
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Affiliation(s)
- O Toumi
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
| | - F Noomen
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - R Salem
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - H Rabeh
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - S B Jabra
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - I Korbi
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - S Bannani
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - M Nasr
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - K Zouari
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - G Mondher
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
| | - A Hamdi
- Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia
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Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8:1169-1181. [PMID: 27729953 PMCID: PMC5055586 DOI: 10.4254/wjh.v8.i28.1169] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/11/2016] [Indexed: 02/06/2023] Open
Abstract
Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence.
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Affiliation(s)
- Memmet Mihmanli
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Ufuk Oguz Idiz
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Cemal Kaya
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Uygar Demir
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Ozgur Bostanci
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Sinan Omeroglu
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
| | - Emre Bozkurt
- Memmet Mihmanli, Ufuk Oguz Idiz, Cemal Kaya, Uygar Demir, Ozgur Bostanci, Sinan Omeroglu, Emre Bozkurt, Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey
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Gómez R, Allaoua Y, Colmenares R, Gil S, Roquero P, Ramia JM. Hydatid cyst of the gallbaldder: A systematic review of the literature. World J Hepatol 2016; 8:1087-1092. [PMID: 27660675 PMCID: PMC5027000 DOI: 10.4254/wjh.v8.i25.1087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/04/2016] [Accepted: 07/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate all the references about primary gallbladder hidatidosis looking for best treatment evidence. METHODS Search: 1966-2015 in MEDLINE, Cochrane Library, SciELO, and Tripdatabase. KEY WORDS "gallabladder hydatid disease" and "gallbladder hydatid cyst". We found 124 papers in our searches but only 14 papers including 16 cases were about hydatid cyst of the gallbladder (GBHC). RESULTS Eight cases of GBHC were women and seven men. One not mentioned. Median age was 48.3 years. The most frequent clinical symptom was abdominal pain (94%) usually in the right upper quadrant. Ultrasound was performed in ten patients (62.5%) but in most cases a combination of several techniques was performed. The location of the cysts was intravesicular in five patients. Five patients presented GBHC and liver hydatid cysts. Two patients presented cholelithiasis and one choledocholithiasis. The most frequent surgical technique was cholecystectomy by laparotomy (81.25%). Simultaneous surgery of liver cysts was carried out in five cases. Eleven patients did not present postoperative complications, but one died. The mean hospital stay was seven days. No recurrence of GBHC was recorded. CONCLUSION In GBHC, the most frequent symptom is right hypocondrium pain (evidence level V). Best diagnostic methods are ultrasound and computed tomography (level V, grade D). Suggested treatment is open cholecystectomy and postoperative albendazole (level V, grade D) obtaining good clinical results and none relapses.
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Affiliation(s)
- Roberto Gómez
- Roberto Gómez, Yousef Allaoua, Rafael Colmenares, Sergio Gil, Pilar Roquero, Faculty of Medicine, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Yousef Allaoua
- Roberto Gómez, Yousef Allaoua, Rafael Colmenares, Sergio Gil, Pilar Roquero, Faculty of Medicine, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Rafael Colmenares
- Roberto Gómez, Yousef Allaoua, Rafael Colmenares, Sergio Gil, Pilar Roquero, Faculty of Medicine, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Sergio Gil
- Roberto Gómez, Yousef Allaoua, Rafael Colmenares, Sergio Gil, Pilar Roquero, Faculty of Medicine, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - Pilar Roquero
- Roberto Gómez, Yousef Allaoua, Rafael Colmenares, Sergio Gil, Pilar Roquero, Faculty of Medicine, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
| | - José M Ramia
- Roberto Gómez, Yousef Allaoua, Rafael Colmenares, Sergio Gil, Pilar Roquero, Faculty of Medicine, Universidad de Alcalá, 28805 Alcalá de Henares, Spain
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Aghayev RM. Liver Echinococcosis complicated with Lesions of Bile Ducts in Azerbaijan. Euroasian J Hepatogastroenterol 2016; 6:125-130. [PMID: 29201743 PMCID: PMC5578579 DOI: 10.5005/jp-journals-10018-1183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/29/2016] [Indexed: 11/29/2022] Open
Abstract
A total of 302 patients with liver echinococcosis (LE) complicated by lesions of bile duct during 1988 to 2015 were analyzed. The patients were divided into two groups. In the first group, 227 patients were included with lesions of segmental bile ducts in the form of cystobiliary and bilio-bronchial fistulas. In the second group, 75 patients with lesions of hepatic bile were enrolled. Diagnosis of LE and its complications was made by ultrasonography and computed tomography (CT). Surgical treatment included echinococcectomy with complete liquidation of a residual cavity (35.1%), echinococcectomy with suturing (46.0%), external drainage of a residual cavity (7.3%), pericystectomy (8.6%), and resection of a liver (3.0%). Postoperative complications related to operative intervention developed in 29 patients. Lethal outcomes took place in 6 cases (2.0%). The analysis has shown that the form of bile duct lesions, methods of surgical operation for liquidation of hydatid cysts, and its biliary complications had influenced the treatment outcome. More optimal results are received after complete liquidation of residual cavity in different ways and suturing of cystobiliary fistulas during operation. For prevention of complications related to the presence of residual cavity, laser processing of walls of a residual cavity by ozonized 17% hypertonic solution of NaCl was used and this procedure showed obvious (p < 0.05) advantages.
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Affiliation(s)
- Rauf M Aghayev
- Department of Surgical Diseases-II, Azerbaijan Medical University, Baku, Azerbaijan
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Vennarecci G, Manfredelli S, Guglielmo N, Laurenzi A, Goletti D, Ettorre GM. Major liver resection for recurrent hydatid cyst of the liver after suboptimal treatment. Updates Surg 2016; 68:179-84. [PMID: 27126358 DOI: 10.1007/s13304-016-0368-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 04/16/2016] [Indexed: 12/24/2022]
Abstract
Recurrent hydatid disease (HD) of the liver after a previous suboptimal invasive treatment is a clinical situation not well codified in terms of management and surgical treatment. Between June 2001 and July 2015, 1525 liver resection were performed at our unit, of whom 217 were with a laparoscopic and 20 with a robotic approach. The most common indications were hepatocellular carcinoma grown on a cirrhotic liver and colorectal metastasis. During the same period, we performed liver surgery for HD in 34 patients (21 females, 13 males). This retrospective study focused on the management and surgical treatment of three unusual cases of recurrent hydatid cyst. All patients had a course of perioperative albendazole. Thirty-four patients had a surgical treatment [open surgery in 30 (88 %) and laparoscopic in four (12 %)]. Surgical procedures were classified as radical resections in 33 patients [total cystopericystectomy (10), left lateral hepatectomy (5), left hepatectomy (2), right hepatectomy (7), segmentectomy/bisegmentectomy (9)]. One patient underwent subtotal pericystectomy as the cyst was close to a major vascular pedicle in a cirrhotic liver. Post operative complications of grade I-II occurred in 11 (32 %) patients, of grade III-IV in one (3 %). Three patients had HD recurrence after a previous suboptimal invasive treatment [PAIR (2), unroofing (1)] and all had to undergo a major liver resection for the complete removal of parasites. The HD first relapse rate for the whole surgical series was 3 %. The second relapse rate was 33 %. The overall survival rate was 100 %. Operations for recurrent HD of the liver represent a surgical challenge due to volume of the cyst, presence of adhesions related to previous invasive treatments and proximity to major vascular structures of the liver. In such instances, pericystectomy can be difficultly achieved making necessary a formal major liver resection.
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Affiliation(s)
- Giovanni Vennarecci
- Division of Surgical Oncology and Liver Transplantation, San Camillo Hospital, POIT San Camillo-INMI Lazzaro Spallanzani, Cir.ne Gianicolense N° 187, 00100, Rome, Italy.
| | - Simone Manfredelli
- Division of Surgical Oncology and Liver Transplantation, San Camillo Hospital, POIT San Camillo-INMI Lazzaro Spallanzani, Cir.ne Gianicolense N° 187, 00100, Rome, Italy
| | - Nicola Guglielmo
- Division of Surgical Oncology and Liver Transplantation, San Camillo Hospital, POIT San Camillo-INMI Lazzaro Spallanzani, Cir.ne Gianicolense N° 187, 00100, Rome, Italy
| | - Andrea Laurenzi
- Division of Surgical Oncology and Liver Transplantation, San Camillo Hospital, POIT San Camillo-INMI Lazzaro Spallanzani, Cir.ne Gianicolense N° 187, 00100, Rome, Italy
| | - Delia Goletti
- Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Rome, Italy
| | - Giuseppe Maria Ettorre
- Division of Surgical Oncology and Liver Transplantation, San Camillo Hospital, POIT San Camillo-INMI Lazzaro Spallanzani, Cir.ne Gianicolense N° 187, 00100, Rome, Italy
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Busto Bea V, Barrio Andrés J, Almohalla Álvarez C. [Liver hydatid disease: Still a problem]. Med Clin (Barc) 2016; 146:367-71. [PMID: 26823109 DOI: 10.1016/j.medcli.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Victoria Busto Bea
- Servicio de Aparato Digestivo, Hospital Universitario Río Hortega, Valladolid, España.
| | - Jesús Barrio Andrés
- Servicio de Aparato Digestivo, Hospital Universitario Río Hortega, Valladolid, España
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Li H, Song T, Shao Y, Aili T, Ahan A, Wen H. Comparative Evaluation of Liposomal Albendazole and Tablet-Albendazole Against Hepatic Cystic Echinococcosis: A Non-Randomized Clinical Trial. Medicine (Baltimore) 2016; 95:e2237. [PMID: 26825878 PMCID: PMC5291548 DOI: 10.1097/md.0000000000002237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this study, we aimed to compare the clinical efficacy of liposomal albendazole (L-ABZ) and tablet-albendazole (T-ABZ) for the treatment of human hepatic cystic echinococcosis (CE). Sixty patients with single cyst (CE1) or daughter cyst (CE2) were included in this study and were nonrandomly divided into the L-ABZ group (n = 30, 10 mg/kg per day, p.o., b.i.d.) and T-ABZ group (n = 30, 12-20 mg/kg per day, p.o., b.i.d.), respectively. The treatment duration lasted for 6 months, during which dynamic follow-up was carried out to evaluate the clinical efficacy through calculating the total effective rates (TERs). Measurement data and numerous data were analyzed by the chi-square test. Two-sided tests were performed for all the statistical tests. In our study, 2 patients were lost in the follow-up in the L-ABZ group. One patient was lost in the follow-up in the T-ABZ group, and 1 patient was withdrawal from the study due to receiving surgery. Significant difference was identified in the 3-month TERs of L-ABZ group and T-ABZ group (33.3% vs 76.7%, P < 0.05). Also, remarkable difference was noted in the 6-month TERs in the L-ABZ group and T-ABZ group (66.7% vs 93.3%, P = 0.01). No statistical difference was noticed in the incidence rate of adverse reactions in both groups (P > 0.05). Based on our study, both T-ABZ and L-ABZ are effective for treating human CE. The TER in the L-ABZ group is superior to that of T-ABZ.
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Affiliation(s)
- Haitao Li
- From the State Key Lab Incubation Base of Xinjiang Major Diseases Research (2010DS890294) and Xinjiang Key Laboratory of Echinococcosis (HL, TS, YS, TA, AA, HW); Hepatobiliary & Hydatid Department, Digestive and Vascular Surgery Centre (HT, TA, AA, HW); and Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China (TS, YS)
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Jain N, Sethi S, Gupta N, Goel V, Puri SK. Comprehensive Evaluation of Cardiac Hydatid Using 256 Slice Dual Source CT: One Stop Shop. J Clin Diagn Res 2015; 9:TD01-3. [PMID: 26557591 DOI: 10.7860/jcdr/2015/13679.6550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/03/2015] [Indexed: 11/24/2022]
Abstract
Hydatid disease results from infection with larval stage of Echinococcus granulosus tapeworm. Dogs and other canines are the definitive hosts; Human beings are common accidental intermediate hosts. Liver is the most common organ to be involved in this condition. Cardiac hydatid, seen in only 0.5 to 2% cases, is a rare entity because of myocardial contractility. Larvae reach the myocardium through coronary circulation. Among various locations of cardiac hydatid, due to its rich coronary arterial supply Left ventricle (LV) myocardium is the most common site of involvement followed by interventricular septum and right ventricle. Rare locations include pericardium, right atrium and left atrium. A 50-year-old woman presented with dyspnoea for 11 months, chest X-ray showed a well defined, homogenous left paracardiac mass, which is not separable from left heart border. Transthoracic echocardiography revealed a complex multicystic mass lesion abutting antero-lateral wall of left ventricle. Contrast enhanced computed tomography showed a well-circumscribed multicystic mass lesion with honeycomb appearance arising from myocardium of anterolateral wall of left ventricle. Indirect haemagglutination test for hydatid disease was positive. At surgery the cyst was seen to arise from LV myocardium. It was incised and grape like contents were evacuated. The cavity was irrigated with scolicidal solution. Thereafter, the cyst was marsupialised. Histopathological examination revealed grape like cyst contents consistent with the diagnosis of hydatid cyst.
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Affiliation(s)
- Neeraj Jain
- Senior Resident, Department of Radiology, G B Pant Hospital , New Delhi, India
| | - Sonali Sethi
- Senior Resident, Department of Radiology, G B Pant Hospital , New Delhi, India
| | - Nishant Gupta
- Senior Resident, Department of Radiology, G B Pant Hospital , New Delhi, India
| | - Vandana Goel
- Assistant Professor, Department of Radiology, G B Pant Hospital , New Delhi, India
| | - Sunil Kumar Puri
- Head and Director Professor, Department of Radiology, G B Pant Hospital , New Delhi, India
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Surgical management of liver hydatid disease: subadventitial cystectomy versus resection of the protruding dome. World J Surg 2015; 38:2113-21. [PMID: 24969045 DOI: 10.1007/s00268-014-2509-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to compare postoperative outcome and long-term results after management of liver hydatid cysts (LHC) by subadventitial cystectomy (SC) and resection of the protruding dome (RPD) in two tertiary liver surgery centers. METHODS Medical records of 52 patients who underwent SC in one center, and 27 patients who underwent RPD in another center between 1991 and 2011 were reviewed. Patients underwent long-term follow-up, including serology tests and morphological examinations. RESULTS Postoperative mortality was nil. The rate of severe morbidity was 7.7 and 22% (p = 0.082), while the rate of serological clearing-up was 20 and 13.3% after SC and RPD, respectively (p = 1.000). After a mean follow-up of 41 months (1-197), four patients developed a long-term cavity-related complication (LTCRC) after RPD (including one recurrence) and none after SC (p = 0.012). All LTCRCs occurred in patients with hydatid cysts located at the liver dome; three required an invasive procedure by either puncture aspiration injection re-aspiration (N = 1) or repeat surgery (N = 2). CONCLUSIONS RPD exposes to specific LTCRC, especially when hydatid cysts are located at the liver dome, while SC allows ad integrum restoration of the operated liver. Therefore, SC should be considered as the standard surgical treatment for LHC in experienced hepato-pancreato-biliary centers.
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Alam-Eldin YH, Badawy AF. Destructive effect of gamma irradiation on Echinococcus granulosus metacestodes. Parasitol Res 2015; 114:3145-50. [DOI: 10.1007/s00436-015-4533-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/06/2015] [Indexed: 12/18/2022]
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