Chapter 67 - Management of Echinococcal Cyst Disease of the Liver

Abstract

Hydatid cysts are most commonly caused by two species in humans: E. granulosus and E. multilocularis, which cause cystic and alveolar echinococcosis, respectively. As an accidental intermediate host, humans become infected by ingestion of embryonated eggs and harboring the parasite in the liver. Clinical evaluation and noninvasive radiologic imaging based on the WHO PNM classification system is crucial in proper management of patient with hydatid liver disease. Combining chemotherapy with surgical management is often necessary for efficient treatment of the disease. The minimally invasive approach with the puncture, aspiration, injection, and respiration (PAIR) technique reduces hospitalization time and improves efficacy of medical treatment. Chemical prophylaxis with albendazole is recommended in the perioperative period. Surgical resection such as unroofing or capitonnage of the cyst or a total pericystectomy should be reserved for complicated liver cysts. Palliative liver surgery and liver transplantation should be kept in mind for extensive alveolar liver echinococcosis. Chemotherapy should be carried out for at least 2 years after surgery. A long-term surveillance should be performed in high risk posttransplant immunocompromised patients.