Complicated Cysts Research Articles

Everolimus on cystic kidney disease burden reduction in pediatric tuberous sclerosis complex patients: a case series

BackgroundTuberous Sclerosis complex (TSC) is a multisystemic neurocutaneous genetic condition with high rates of morbidity and mortality from subependymal giant cell astrocytoma (SEGA), renal angiomyolipoma, and renal cyst complications. Everolimus is an inhibitor for mTORC1 and is currently used to treat TSC for its main role in rapidly reducing SEGA volume and seizure burden, although mainly studied in the adult population. It has also been shown to stabilize estimated glomerular filtration rate and reduce renal angiomyolipoma size in the adult population.Case presentationThis case report illustrates three pediatric patients placed on everolimus for SEGA and seizure control with incidental findings of the disappearance of or decreased burden of cystic kidney disease after everolimus therapy. In one patient, the cyst burden remained stable even after the cessation of everolimus while the SEGA resumed growth.ConclusionsThis report demonstrates the utility of everolimus in not only renal angiomyolipomas but also cystic kidney disease particularly in pediatric patients with a promising role in preserving renal function and preventing long term sequelae such as hematuria and hemorrhage from larger renal cysts especially if used early on in disease course.

Outcomes and Risk Factors for Morbidity After Lung Hydatidosis Surgery in Children

To examine outcomes and associated risk factors for children who undergo surgery for lung hydatidosis (LH). Through a retrospective and analytical-aim-study, over a period of 35 years in two surgical departments, we reported all operative cases for LH in children, regardless of cyst number, location, and aspect. Univariate and multivariable analyses were used to assess variables potentially predictive of postoperative morbidity. In total, 456 children with a mean age of 10.3 years were included. We performed 544 surgical procedures for 704 cysts with a median size of 60 mm (range 10-200 mm). Thirty-six percent of cysts were complicated. Conservative surgery was performed in 98.5% of cases and anatomical lung resection was required for 1.47% of children. Postoperative complications occurred in 24.4% of children and one death was recorded (0.2%). After multivariable analysis, the independent associated morbidity risk factors for post-operative morbidity were anatomical lung resection, intensive care unit stay, complicated cyst, a cyst size ≥60mm, ≥3 bronchial fistulas, associated liver hydatidosis, and the presence or occurence of empyema during surgery. Conservative surgery sparing the lung parenchyma is the treatment of choice for lung hydatidosis and is associated with a low mortality rate. Knowledge of independent risk factors for morbidity may help clinicians to manage children with LH more adequately and improve postoperative outcomes.

Endoscopic definitive treatment of liver hydatid cysts ruptured into bile duct.

Intrabiliary rupture (IBR) is one of the most common complications of hepatic hydatid cysts (HHC),and the surgical treatment of major intrabiliary rupture (MIBR) leads to serious morbidity and mortality. This study aimed to evaluate the efficacy of endoscopic definitive treatment of these patients. This study included 38 patients who underwent ERCP for MIBR between 2004 and 2022. Endoscopic sphincterotomy (ES) was performed, followed by evacuation of hydatid contents from the main bile ducts and cyst cavity. A nasobiliary drainage (NBD) catheter was placed inside the cyst cavity in 15 patients, while biliary stenting (BS) was performed in 23 patients. Demographic data, cyst characteristics, hospital stay, complications, treatment success, and recurrence were analyzed. The mean age of patients was 46.5 years, with 12 female and 26 male. All patients had WHO-type-3B hydatid cysts with an average diameter of 7.9 cm. NBD was continued for definitive purposes in 13 of the 15 patients who underwent NBD, and full cure was achieved in 13 patients. Among the 23 patients who underwent biliary stenting (BS), 16 (69.5%) required a second ERCP due to jaundice or cholangitis, and 6 (26%) underwent percutaneous drainage due to hydatid cavity infection. The average length of hospital stay was 16.13 days in the BS group, while it was 8.3 days in the NBD group.The average follow-up period was 23 months. All patients achieved complete recovery. The endoscopic approach is an effective and safe method for the treatment of MIBR, and can be considered as a definitive treatment option in centers with adequate resources and experienced endoscopists.

Endoscopic Treatment of Biliary Complications of Hydatid Cysts of the Liver

Endoscopic Treatment of Biliary Complications of Hydatid Cysts of the Liver

Predictive Factors of Pulmonary Hydatid Complications in Children

BackgroundPulmonary echinococcosis in children has frequent and severe complications. The aim of our study was to determine predictive factors of pre and postoperative complications of pediatric pulmonary hydatid cyst. MethodsWe conducted a retrospective descriptive and analytic study conducted from January 2010 to December 2018. The study population was divided into two groups to determine predictive factors of pre- and post-operative complications of pediatric pulmonary echinococcosis. Data were analyzed by IBM SPSS 21.0. A p-value of 0.05 was accepted as significant. ResultsThe study included 106 boys and 94 girls with a median age of 8 years. One hundred and thirty-eight patients (69%) had complicated pulmonary hydatid cyst preoperatively. Univariate analysis identified 12 predictive factors of pre-operative complications: rural origin (p = 0.0001), hydatid contact (p < 0.001), long period between the onset of symptoms and the first medical consultation (p = 0.0001), the autumn and the winter (cold seasons) (p = 0.0001), chest pain (p = 0.0001), hemoptysis (p = 0.023), fever (p = 0.0001), right side (p = 0.01), apical and para hilar location (p = 0.01), superior lobe (p = 0.05), superior right lobe (p = 0.0001), cyst size>5 cm (p = 0.02), positive hydatid serology (p < 0.0001). It identified 2 predictive factors of post-operative complications: giant cyst (p = 0.009) and not performing a capitonnage (p = 0.016). Multivariate analysis showed 4 independent pre-operative predictive factors of complications: rural area (p < 0.0001), fever (p = 0.006), right side (p = 0.02) and positive hydatid serology (p < 0.001). It identified 2 postoperative independent predictive factors of complications: not performing. capitonnage (p = 0.029) and solitary hydatid pulmonary cyst (p = 0.02). ConclusionPulmonary hydatid cyst management in children needs a thorough appreciation of independent predictive factors of pre and postoperative complications in order to reduce their morbidity.

Construction of nomogram based on clinical factors for the risk prediction of postoperative complications in children with choledochal cyst.

The aim of the study was to develop a prediction nomogram based on clinical factors to assess the risk of postoperative complications in children with congenital choledochal cyst. The clinical data from 131 children who underwent choledochal cyst resection and Roux-en-Y hepaticojejunostomy in our hospital between January 2016 and December 2022 were retrospectively analyzed. The general information, clinical symptoms, procedure, biochemical indicators, and imaging data were recorded. A prolonged hospital stay induced by postoperative complications or a follow-up over 6 months was assessed as the event outcome. A logistics regression analysis was performed to screen for risk factors with statistical significance in inducing postoperative complications. Then, with the dataset split into the training group and internal validation group, the nomogram for the prediction of postoperative complications was developed based on a computer algorithm. In addition, the receiver operating characteristic (ROC) curve and calibration curve were performed for nomogram verification. Of 131 children, the multivariate logistics regression analysis suggested that age ≤2 years [odds ratio (OR) 0.93; 95% confidence interval (CI) 0.15-5.65; p = 0.938], Todani classification type 1 (OR 36.58; 95% CI 4.14-871.74; p = 0.005), cyst wall thickness >0.4 cm (OR 10.82; 95% CI 2.88-49.13; p < 0.001), with chronic cholecystitis (OR 7.01; 95% CI 1.62-38.52; p = 0.014), and choledochal cyst diameter (OR 1.01; 95% CI 0.99-1.03; p = 0.370) were predictors associated with the postoperative complications of choledochal cysts. The data were randomly divided into the training group (n = 92) and internal validation group (n = 39) to build the prediction nomogram including the appeal factors. The accuracy and discrimination of the model were evaluated using a ROC curve and calibration curve. The results showed that the nomogram area under the ROC curve [area under the curve (AUC) = 0.894; 95% CI 0.822-0.966; p < 0.001], validation (AUC = 0.844; 95% CI 0.804-0.952; p < 0.001), and Brier = 0.120 (95% CI 0.077-0.163p; p < 0.001) were indicative of the good stability and calibration of the predictive nomogram. The prognosis of congenital choledochal cysts was associated with multiple aspects of clinical factors. Combined with the internal validation, the novel prediction nomogram was suitable for evaluating the individualized risk of postoperative complications of choledochal cysts. The prediction nomogram could provide a more accurate strategy of procedure and postoperative follow-up for children with choledochal cysts.

A case series of post-tuberculous Baker's cyst

IntroductionThe gastrocnemius-semimembranous bursa of the knee, which connects to the posterior region of the joint capsule, becomes distended in a Baker's (popliteal) cyst. In adults, it is nearly always secondary to pathological changes in the knee joint that cause an effusion. Baker cysts are mostly asymptomatic, but they may have presentations ranging from mild swelling, a picture similar to infective arthritis, to massive swelling leading to rupture and causing lower limb ischemia. We have presented these cases of post-tubercular baker cysts and evaluated their post-treatment outcomes. Material and methodsBetween September 2018 and September 2021, 12 patients with post-tuberculous baker cysts who presented to the outpatient department or emergency department of our institute were treated with conservative or open excision and followed up for 12 months at regular intervals. The functional assessment was done by VAS pain scoring and Lysholm knee scoring at the start of treatment, 1, 6 and 12 months after the surgery or conservative treatment. Results8 patients with post-tubercular Baker cysts were managed conservatively with aspirations and medications. Four patients with large multiloculated post-tubercular baker cysts were managed operatively. The mean age of patients with complicated post-tuberculosis Baker cyst was 44.92 ± 5.07 years. VAS The scoring of all the patients improved with each visit and 1-year follow-up. The Lysholm Knee score of patients also improved with each visit. All patients had excellent scores, with 3 patients having a score of 100 at 1-year follow-up. ConclusionComplicated Baker's cysts with multiloculated post-tubercular cysts need surgical management in most cases. Excellent to good functional outcomes can be achieved in these unusual cases with prompt intervention, detailed work-up, and medications.

Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study.

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. 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. 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. 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.

The localization, treatment, and complications of dermoid cysts in the eyebrow region

Dermoid cysts are congenital lesions characterized by skin appendages and surrounding epithelial tissue with a well-defined cyst wall, accounting 40% of all pediatric lesions. The most common location is frontotemporal, orbital and nasoglabellar region. Diagnosis is based on physical examination and imaging in selected cases. Surgical excision is recommended as the preferred course of treatment. Presentation, classification, differential diagnosis, imaging methods and algorithms, surgical techniques and complications are discussed based on the recent literature.

Surgical Management for Complicated Hydatid Cyst of the Lung about 94 Cases

Introduction: Pulmonary hydatid disease is a parasitic infestation endemic in many sheep and cattle farming regions, particularly in Algeria. Complicated forms are a frequent occurrence and characterized by radio-clinical polymorphism and therapeutic difficulties. Material and Methods: This is a retrospective study (2017—2023) including 94 cases of complicated hydatid cyst of lung. Results: Complicated hydatid cyst of lung represented 22.76% of all hydatid cyst of lung treated surgically in our department. The average age was 27.8 years (4—56 years) with a slight male predominance 57.45%. The circumstances of discovery were dominated by cough in 54.26% and hemoptysis in 32.99%. The definitive diagnosis was made on the radio-clinical and biological findings. The treatment was surgical in all cases, conservative treatment was practiced in 87.03%, and parenchymal resection was performed in 16 patients. Postoperative hydatid recurrence was noted in only one patient. Conclusion: Hydatid cyst of the lung is a common zoonosis in Algeria. Its treatment is essentially surgical and must be initiated quickly once the diagnosis is established in order to avoid progression towards complications that are sources of diagnostic and therapeutic difficulties.

Arachnoid cyst in the pediatric patient: What the radiologist needs to know.

Arachnoid cysts are the most common incidentally discovered intracranial lesions on imaging and the most common cystic intracranial lesions. They may be developmental or secondary. A relative lack of recent literature and any comprehensive radiological review on arachnoid cysts has led to a general lack of awareness among radiologists of symptomatic or complicated arachnoid cysts. This is particularly concerning in pediatric patients. While arachnoid cysts are asymptomatic in most cases, they can cause clinical symptoms in a minority of cases, especially when they occur in unusual sites. These include intraventricular locations where they may cause hydrocephalus, the basal cisterns where they may compress cranial nerves, the cerebellopontine angle where they have to be differentiated from a number of cystic lesions, the cavum septum pellucidum or cavum velum interpositum, the choroid fissure where they can entrap the temporal horn and compress the hippocampus, the posterior fossa where they need to be differentiated from other posterior fossa cystic lesions, and within the spinal canal where there is a concern for cord or nerve root compression. Larger cysts are more prone to complications such as mass effect, hemorrhage, and rupture. Hemorrhage and rupture often present with acute symptoms. Ruptured cysts lose their characteristic imaging appearance and can mimic several ominous pathologies. It therefore becomes vital to accurately diagnose these cases as complications of pre-existing arachnoid cysts for appropriate management. A detailed review of all diagnostic imaging aspects of arachnoid cysts will help fill in the existing information void on this important entity.

Analysis by literature review with PRISMA 2020 methodology of laparoscopic surgical complications of ovarian cysts

Laparoscopic surgery in the removal of ovarian cysts is one of the most widely used procedures in the world today due to its multiple advantages, but the procedure is not free of complications. The aim of this study was to analyze, by means of a literature review using PRISMA 2020 methodology, the laparoscopic surgical complications of ovarian cysts. The study was framed in the exploratory research level, using hermeneutics to analyze the systematic review developed in the databases Medline, PubMed, ScienceDirect and Google Scholar, from which 16 documents were finally included. It was shown that the main complications of laparoscopic surgery are vascular and intestinal damage, but less serious and frequent complications such as bladder and urethral damage, hernias and infections can also occur. We found that laparoscopic surgery has emerged as the preferred modality for the investigation, diagnosis and treatment of a wide range of diseases, including ovarian cystectomy. Although this form of minimally invasive surgery has numerous advantages, including a lower incidence of complications, it is not without risk. It was concluded that, although the rate of complications in laparoscopic surgery is lower compared to conventional surgery, more research is needed to improve existing procedures, ensure their safety and create new methods

A Case of Baker’s Cyst with Synovial Chondromatosis of Knee

Synovial chondromatosis is a benign condition which arises from synovial membrane or bursae around the joints. Joint abnormalities in the form of arthritic or mechanical conditions such as detachment of osseocartilaginous fragments from the articular surface are its secondary associations. Rarely there maybe involvement of the Baker’s cyst. Here we report a case in which a 60-year-old female came with complaints of pain, swelling and restriction of movement of right knee joint for the past one year. After careful clinical and radiological examination, it was diagnosed as Baker’s cyst complicated by synovial chondromatosis. After the diagnosis the patient underwent the following procedures: open synovectomy, cyst removal and thorough joint debridement. Synovial chondromatosis was confirmed histopathologically. Secondary synovial chondromatosis has features of osteoarthritic changes, lack of extensive synovial proliferation and complicated Baker's cyst which is not seen in primary synovial chondromatosis.&#x0D; Synovial chondromatosis (SC) is caused by metaplasia of the synovium into chondrocytes and is a rare benign disorder.[1,2] Primary synovial chondromatosis (PSC) is a self-limited process that occurs in an otherwise normal joint.[3] When synovial chondromatosis develops in a joint previously affected with disease, often posttraumatic or degenerative osteoarthritis, it is called as secondary synovial chondromatosis.[4] SC may involve any joint, but the most common joint involved is knee joint followed by hip joint, and small joints of the hand and wrist. Least involvement is seen in elbow and shoulder joint. [5] The disease is categorised into three phases according to Milligram classification: active intrasynovial disease without any loose bodies observed in the early phase, active disease and loose bodies observed in the transitional phase, and multiple loose bodies without any intrasynovial disease observed in the late phase.&#x0D; In orthopaedic practice, popliteal cysts are common occurrence; many of them are associated with degenerative or rheumatoid arthritis. The differential diagnoses become more complex when loose bodies and calcifications are noted within the joint on a radiograph. Here in, we are presenting a case of Baker’s cyst with synovial chondromatosis of knee treated by surgical excision and confirmed by histopathology.

AYURVEDIC MANAGEMENT OF COMPLEX OVARIAN CYST- A CASE REPORT

Cysts in the ovaries can be simple or complex. Ovarian cysts classified as complexes include either blood or a solid material. In routine gynaecological practice, ovarian cystic masses are a prevalent concern. The prevalence of ovarian cysts varies greatly, according to data. According to reports, ovarian cysts affect 8–18% of women who are postmenopausal and premenopausal. The majority of the cysts are asymptomatic and are only found via standard ultrasonography. Some of them are very symptomatic, making it difficult for women to go about their daily lives. The size of the cysts has a significant impact on the symptoms. In modern times, therapy options include combined oral contraceptive pills and surgery to address cysts that don't go away after three months. Due to the numerous adverse effects of oral contraceptives, there is a growing need for other forms of management, particularly among patients who prefer not to undergo surgery. Ayurveda treats ovarian cysts under the general category of Granthi, where they are associated explicitly with Kaphaja Granthi. Treatment for an 18-year-old female patient who had a complicated left ovarian cyst with cystitis, dyspareunia, burning micturition, and significant lower abdominal pain was based on Ayurvedic principles. The patient was administered Srotosanghar Churn, Granthihar Kwath, Capsule Liv Fit, Search Cordial capsule, and Search Cordial syrup for one month. A follow-up USG revealed that the cyst had disappeared entirely, and the symptoms had decreased significantly. The current study highlights how Ayurveda can help control ovarian cysts beneficially.

Ayurvedic Approach for Management of (Hemorrhagic Ovarian Cyst) Andashayagata Raktaja Granthi – A Case Report

Ovarian cysts can be either simple or complicated. Complex ovarian cysts contain either a solid or blood component. A common worry in standard gynecological care is ovarian cystic masses. The findings show that there are wide variations in the prevalence of ovarian cysts. Reports state that 8–18% of post-menopausal and pre-menopausal women have ovarian cysts. Most cysts are asymptomatic and can only be detected by routine ultrasonography. Certain ones are very symptomatic, posing challenges for women in their day-to-day activities. The symptoms are significantly influenced by the size of the cysts. A closed, sac-like structure on or inside the ovary that is filled with a liquid or semi-solid material is called an ovarian cyst. A type of functional cyst known as a hemorrhagic cyst is often referred to as a corpus luteal cyst. Treatment options for cysts that do not go away after 3 months include surgery and a combination of oral contraceptive tablets. The need for alternative kinds of management is increasing as a result of the many adverse effects of oral contraceptives, especially for individuals who would rather not have surgery. Treatment for a 22-year-old female patient who had a complicated right ovarian hemorrhagic cyst with dyspareunia, burning micturition, and significant lower abdominal pain was based on Ayurvedic principles. For one and half months, the patient was administered Gandharva Hastadi Tail, Kachnara Gugglu, Arbudhara Kwatha katuki Churna, Chandanasava, Amrutoz, Dhatriloha, and Sankha Bhasm. A follow-up USG revealed that the hemorrhagic cyst had completely disappeared and that the symptoms had much decreased. The current study highlights how Ayurveda can help control ovarian cysts in a way that is beneficial.

Presentation, diagnosis, management and outcome of complicated hydatid cyst of the lung

Introduction: Introduction: The complicated hydatid cyst of the lung is defined as any cyst ruptured in the bronchi tree or in the pleural cavity, infected, and rarely in the pericardial cavity. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including presentation, diagnosis choice of surgical methods. and complication of delay in surgical treatment of pulmonary hydatid cysts. Methods: Between 2016 and 2021, 192 operations operated for pulmonary hydatid cysts, 42 of these patients were complicated hydatid cyst. Presentations were cough, chest pain and dyspnea.Diagnosis tools were CXR and CT-scan of chest. surgical approach was a posterolateral thoracotomy and anterolateral thoracotomyin all patients; a phrenotomy in eight patients and one-stage bilateral thoracotomy in six patients. Results: In 18 patients (67.5%), there were single hydatid cysts; whereas 4 patients (32.5%) had multiple cysts.12 patients had bilateral cyst and 8 had both lung and liver and others organs, 6 patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in 4 patients. Extrathoracic involvement was apparent in 6 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in 4 patients (16%). Conclusion: Complicated hydatid cyst may present with different clinical and radiologically manifestations as a primary lung tumor , pleural effusion ,empyema hydropneumothorax. In patients with suspicious lung masses in endemic area or history of a hydatid cyst in patients a complicated pulmonary hydatid cyst may be in differential diagnosis.

Pyopneumothorax revealing a complicated hydatid cyst of the lung

Pulmonary hydatidosis remains asymptomatic for a long time, and may be revealed following a complication such as intrapleural rupture. This entity, known as pyopneumothorax, poses a diagnostic problem even in countries with high hydatid endemicity. The aim of this study was to investigate the clinical, radiological and therapeutic aspects of pulmonary hydatid cysts revealed by spontaneous pyopneumothorax. This is a retrospective descriptive study of 5 patients with spontaneous pyopneumothorax revealing complicated pulmonary hydatidosis collected over 8 years at the Pneumology Department, CHU Mohamed VI, Marrakech, Morocco. Patients were younger and male. Clinical signs were dominated by cough and fever. Chest X-ray showed a hydroaeric image. Pleural puncture revealed a purulent fluid. Direct examination and culture of this fluid did not isolate any germs. All patients were drained and put on initial probabilistic antibiotic therapy. In view of the lack of clinical, biological and radiological improvement and the clinical presentation, we suspected complicated pulmonary hydatidosis. CT scan and thoracic ultrasound confirmed the diagnosis of ruptured KHP.

Epidermoid cyst of central nervous system: A case series and review of literature

IntroductionEpidermoid cysts, originating from ectodermal cell remnants during embryogenesis, are rare, slow-growing tumours commonly found in the cerebellopontine angle, fourth ventricle, and sellar/parasellar regions. This retrospective study explores clinicopathological features, demographics, and radiological details of fifteen central nervous system epidermoid cyst cases over three years. Materials and methodsHistologically confirmed cases undergoing surgical excision from July 2020 to July 2023 were retrospectively evaluated. Patient age, clinical presentations, radiological features, and histopathological findings were analyzed using descriptive statistics and aligned with the PROCESS criteria. ResultsFifteen cases, spanning various age groups and clinical presentations, were included. There were four cases each in the posterior fossa and cerebellopontine angle, three in temporal region, two in intraspinal region, and one each in the retromastoid intra-diploic and third intra-ventricular region. Lesions exhibited diverse distribution, gross findings, and microscopic features. Radiological imaging exhibited well-defined hypo-attenuated masses on computed tomography and contributed to the preoperative diagnosis in eight cases. Despite challenges in complete excision due to adherence, 13 cases underwent successful resection. Chemical meningitis, a common postoperative complication, underscores the importance of meticulous surgery. ConclusionThis study highlights clinicopathological characteristics, challenges in surgical management, and postoperative complications of central nervous system epidermoid cysts. Comparative analysis with existing literature emphasizes the uniqueness of epidermoid cysts, differentiating them from craniopharyngiomas and dermoid cysts. Despite the retrospective design, valuable insights are provided, emphasizing the need for prospective studies. Effective management involves complete excision, ensuring long-term remission and emphasizing the distinctive nature of these intriguing intracranial lesions.

Laparoscopic choledochal cyst excision and biliary reconstruction in patients with previous surgery/ intervention: Feasibility and outcome.

The aim of the study was to evaluate the feasibility and outcome of laparoscopic surgery in complicated choledochal cyst (CDC) with previous interventions (laparotomy or biliary drainage). Patients with CDC who underwent surgery from July 2014 to July 2019 were evaluated. CDC without previous interventions (Group A) was compared with CDC that had previous interventions (Group B) to assess the feasibility and outcome of laparoscopic surgery. In 5 years' period, 38 patients were operated for CDC. The mean age was similar in both groups (3.78 ± 2.27 in Group A and 4.08 ± 2.73 in Group B). Out of six CDC with previous intervention (Group B), five patients were previously managed at other institutions as follows: (1) Laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) stenting. (2) Laparotomy for biliary peritonitis and ERCP. (3) Percutaneous drainage of the large cyst. (4) Laparoscopic cholecystectomy. (5) ERCP stenting. (6) Percutaneous drainage for biliary ascites. All patients underwent laparoscopic CDC excision and hepatico-duodenostomy. The mean duration of surgery was 160.3 ± 17.22 in Group A and 169.2 ± 17.5 in Group B ( P = 0.258). None required intraoperative blood transfusion. None had a bile leak. Drain was removed at 4.47 ± 0.98 in Group A, while at 4.17 ± 0.75 days in Group B ( P = 0.481). There was statistically no significant difference in feed starting time or length of stay. In follow-up of 6 months-3 years, all patients are asymptomatic. Laparoscopy in complicated CDC with previous intervention is technically tedious but is feasible. The procedure is safe and delivers a good outcome.

Hirurško lečenje komplikovane hidatidoze ductus choledochus-a tokom pandemije COVID-19 - efikasnost i ograničenja radiološke službe i hirurgije u vanrednim uslovima

Introduction: While uncomplicated echi-nococcal cysts can grow in the liver for years without symptoms, complicated hydatid cysts (CHC) present distinct clinical characteristics that necessitate urgent treatment. Case Report: We present a case of acute biliary obstruction, cholangitis, and sepsis due to massive cho-ledocho-hydatididosis in an 84-year-old COVID-positive patient during the COVID-19 pandemic. Imaging revealed a multicystic lesion in liver segments V and VIII that compressed surrounding liver tissue, leading to intrahepatic duct dilation. A daughter cyst in the ductus choledochus was confirmed during surgery. An attempt at endoscopic retrograde cholangiopancrea-tography (ERCP) was unsuccessful. We performed an open pericystectomy with total cystectomy and choled-ochotomy, carefully evacuating all hydatid cysts. The postoperative course was uneventful, and the patient was discharged without surgical complications. Conclusion: Complicated hydatid cysts (CHC) leading to acute biliary obstruction require prompt diagnosis and indicate the need for rapid evacuation of the cyst and correction of complications.