Management of Complicated Hydatid Cyst in Pregnancy. A Multicenter Study

Abstract

The hepatic hydatid cyst is a major public health concern in endemic areas. It presents a therapeutic challenge when it occurs in pregnant women and exposes the mother and the fetus to a high mortality risk in the case of complications. The main complication is communication with the biliary tree, which fortunately is rare. A multi-center retrospective study was conducted spanning 7 years, from January 2009 to December 2015. In 17 departments of surgery across Tunisia, 24 cases were identified of pregnant women who were treated for complicated hepatic hydatid cyst. The data on their treatment and outcome were retrieved from the medical records. The age range of the 24 patients was 23 to 40 years, median 30 years. The median gestational age was 15 weeks (range 5 to 29 weeks).The patients complained of a variety of symptoms, mainly abdominal pain (87.5%), fever (50%), jaundice (50%) and vomiting (21%). The laboratory examination showed leukocytosis (54.2%), cholestasis (41.7%), elevated liver enzymes (12%), and positive blood culture (6%). On abdominal ultrasound (U/S), dilatation of the common bile duct was observed in 41% of the cases, dilatation of the intra-hepatic bile ducts in 50%, and hydatid material in the duct in 12% of the cases. Most of the cysts were located in the right lobe of the liver, in the hepatic dome. All of the patients were treated surgically, by one of three types of intervention: Largot intervention (18 cases), internal transfistulary drainage (4 cases), and the Perdromo procedure (2 cases). Postoperative follow-up was complication-free for 20 patients. In the remaining four, complications included: purulent retention (1 case), biliary fistula (2 cases), pneumonia (1 case). There was no maternal death. A tocolytic agent was administered to 16 women and 21 had a live full-term birth. One spontaneous miscarriage and 2 neonatal deaths occurred. Complicated hydatid cyst in pregnancy is a serious condition which can be life-threatening for the mother and the fetus. The treatment is surgical, and patient management requires close collaboration between the surgeon, the anesthesiologist and the obstetrician-gynecologist.