Complicated Hydatid Cyst Research Articles

Thoracoscopic Cystostomy of Pulmonary Hydatid Cyst in Children

Aim: Echinococcosis is still an important health problem throughout the world, particularly in the Mediterranean area. In humans, the lungs are the second most commonly affected sites. The disease may affect children and its treatment may be challenging. In children, small hydatid cysts of the lungs respond favorably to the medical treatment. Surgery is the standard option for the treatment of large and complicated cysts. In current practice, thoracotomy and parenchyme-saving procedures such as cystostomy and capitonnage remain the standard surgical approach for pulmonary hydatid cysts in children. However, surgical experience with thoracoscopy is limited. The aim is to present the experience in thoracoscopic management of pulmonary hydatid cysts in children. Patients and Methods: Medical records of children who underwent thoracoscopic cystostomy of pulmonary hydatid cysts between 2008- 2016 were reviewed. Surgical treatment was recommended for patients who remained symptomatic on medical treatment and when the cyst size was larger than 6 cm in diameter. Parenchyme-saving surgery was preferred which included cystostomy, removal of germinative membrane and control of air leaks. Capitonnage was not preferred because of the risk of deterioration in lung capacity. Results: Fifteen patients underwent 16 thoracoscopy procedures for pulmonary hydatid cysts. One of the patients had bilateral complicated pulmonary hydatid cysts. There were conversions to mini-thoracotomy in 3 (20%) procedures because the air leaks could not be controlled safely. The procedure was completed thoracoscopically in 12 patients. In thoracoscopically completed cases, prolonged air leak (over a week) occurred in 3 (25%) patients and one of them underwent thoracotomy to control bronchopulmonary fistula. One of the patients underwent laparoscopic cystostomy and capitonnage for associated liver hydatid cyst. There were no recurrences during 60 months of mean follow-up time and no problem was observed during the follow-up period. Conclusion: Thoracoscopic management is recommended in children with uncomplicated hydatid cyst. In complicated hydatid cysts, however, thoracoscopic wedge resection is recommended. If there is difficulty in controlling bronchial openings, mini-thoracotomy could be considered.

Management of cysto-biliary communication in hydatid cyst of liver

Introduction: Biliary communication of hepatic hydatosis is one of the important complications. It may be minor or major communication. Minor communication is usually diagnosed during operation by the presence of bile stained hydatid fluid on aspiration or bile leak during surgery. However, in major communication, patients present with obstructive jaundice, abdominal pain and cholangitis. Surgical management of major communication is difficult and is associated with high morbidity and mortality.Methods: This is a retrospective study at Tribhuvan University Teaching Hospital, Kathmandu, Nepal over a period of two year (April 15th 2012 to April 15th 2014) and analyzed the medical records of 30 patients admitted and treated for hydatid cyst of liver in surgical ward during that period. Demography, clinical features, management and outcome were analyzed.Results: Of 30 patients with hepatic hydatid cyst operated over a period of two years, thirteen patients had cystobiliary communication. Amongst them, five minor communications were diagnosed during operation and managed with suture plication and omentopexy. Out of the eight major communications, seven were diagnosed preoperatively and all had cholangitis, and one had hydatid cyst of gallbladder and was diagnosed intraoperatively. Among six cases of major communication, five cases required CBD exploration and bile duct reconstruction while partial cholecystectomy was done for hydatid cyst of gall bladder and one case was managed by ERCP sphincterotomy, evacuation of cyst content and stenting. one case was managed with pigtail drain as the patient had infected hydatid cyst and not fit for surgery.Conclusion: Cystobiliary communication is a common complication of hydatid cyst of liver. Therapeutic options are related to size and location of the cyst and size of communication.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 31-34

Sunflower seed mimicking complicated hydatid cyst

We present a case of a foreign body in lung parenchyma, found incidentally during surgery in an adult woman. The clinical and radiological findings were consistent with a pulmonary hydatid cyst. Owing to the similar clinical and radiological appearances, a thoracotomy was required for the correct diagnosis of a sunflower seed mimicking hydatid disease.

An Unusual Case of Anaphylaxis after Blunt Abdominal Trauma

BackgroundDue to current human migratory patterns, emergency physicians in developed countries are facing emergent clinical presentations of neglected tropical diseases with increasing frequency. In those situations, the clinician's diagnosis is often delayed due to a lack of familiarity with the disease. Case ReportWe present the case of a 25-year-old Peruvian man who presented to the Emergency Department complaining of dyspnea and abdominal pain after upper abdominal trauma. His physical examination revealed mouth and eyelid edema in association with epigastric pain. An abdominal computed tomography scan revealed a liver hydatid cyst. Emergent surgical evacuation of the cyst was required to control the anaphylactic reaction. Why Should an Emergency Physician Be Aware of This?Anaphylaxis in the setting of a complicated hydatid cyst is a life-threatening disease. Critical care management and emergent surgical evacuation of the cyst are indicated.

Imaging in pulmonary hydatid cysts.

Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored.

Minimally Invasive Treatment of Liver Hydatidosis.

Background and Objectives:Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments.Methods:In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging.Results:Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula.Conclusions:In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.

Surgical treatment of complicated liver echinococcosis - Our experience with 184 cases in 10 Years

Background: The aim of this study was to analyze the treatment of patients with complicated liver hydatid cysts. Methods: The records of 184 patients who had undergone surgery for complicated liver hydatid cyst in our institution during 2005 and 2014 were reviewed retrospectively. Results: Among all complications, the most common were intrabiliary rupture (140 patients) and suppuration of the cysts (27 patients). Eleven cases had a combination of two complications. Other complications were rupture in the thorax (4 cases), rupture in the peritoneum (7 patients) and vascular erosions (6 patients). Surgery was based on the nature of complications, number and sizes of hydatid cysts and patients general condition. The surgical treatment of choice was partial (peri) cystectomies and drainage of the residual cavity with suture of the biliary fistula. In cases with complications such as suppuration, remaining bile fistulas, large cyst cavities or extrahepatic location, external drainage of the common bile duct (CBD)was mandatory. Post-operative complications occurred in 45 patients (24.4 %). Postoperative mortality was 1 % (two patients). Conclusion: Appropriate investigation and well planned surgical techniques may improve the outcome of complicated liver echinococcosis. These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.

Uncomplicated Hydatid Cysts of the Liver: Clinical Presentation, Diagnosis and Treatment

Hydatid cyst of the liver is zoonosis caused by the larval stages of taeniid cestodes belonging to the genus Echinococcus and is still endemic in the South European regions, Asia, South America, North Africa, Australia, New Zealand and several Asian and European countries. The diagnosis of non complicated hydatid cyst of the liver depends on clinical suspicion. They appear in two ways as general (systemic) symptoms, and local symptoms based on the site and organ on which larva settles. While cysts sometimes recover spontaneously, more severe clinical presentations are observed in immunosuppressive individuals. Ultrasonography is the gold standard diagnostic tool and E. Granulosus antigen 5 (Ag5) and antigen B (Ag B) obtained from cyst fluid are used as a serologic diagnostic method in combination with the imaging method. The current treatment of hydatid cyst of the liver varies from surgical intervention to minimally invasive treatments (percutaneous drainage) or medical therapies. Surgery is still the best treatment tool. Percutaneous drainage and treatment of the cyst is a good option to surgery in selected cases. Multiple, superficial single cysts are the most suitable ones for surgical treatment. Also for complicated infected cysts pressing biliary tree and vital organs, surgery should be the first choice of treatment coming to mind. We believe that the laparoscopic approach should be safe to uncomplicated cysts. The purpose of our article is to provide a current review of clinical, diagnostic, and therapeutic features of hydrated cyst diseases.

Complications of Hydatid Cysts in the Lung

A hydatid cyst, or echinococcus, is a zoonosis frequently formed by the larvas of Echinococcus granulosus. The disease appears as a slowly growing cystic mass and is asymptomatic. The disease is common in the Eastern, Southeastern, and Central Anatolia regions of Turkey. The rate of incidence of the disease in Turkey is reported as 5.7 out of 100,000 individuals.

Complicated Hydatid Cyst: Ultrasonographic Illusion and Endoscopic Diagnosis

Liver cyst hydatic (LCH) is an important parasitic disease caused by Echinococcus spp. Rupture of the biliary tract is an important and serious complication. It is often diagnosed on a suspicious clinical findings by radiologic imaging procedures. But, complicated hydatid cyst disease can show different radiological images, as they can simulate any disease. Here, we reported a case which diagnosed cholangiocellular carcinoma in primary diagnosis by ultrasonographic evaluation but diagnosed hydatid cyst in endoscopy evaluation. A 30-year-old female patient was admitted to the hospital with 1 year continuous severe abdominal pain aggravated for 1 month.How to cite this articleKefeli A, Basyigit S, Yeniova AO, Nazligul Y. Complicated Hydatid Cyst: Ultrasonographic Illusion and Endoscopic Diagnosis. Euroasian J Hepato-Gastroenterol 2015;5(1):65-66.

Diaphragmatic hydatid cyst: report of three cases

The incidence of diaphragmatic hydatid cysts, isolated or involving other organs, is very rare. Preoperative diagnosis of complicated hydatid cysts located at the diaphragm is challenging. In some cases with a liver cyst the cyst cannot be detected during laparotomy. In this article, we report three diaphragmatic cyst cases who were treated surgically in our clinic within the past 10 years. Cystectomy and primary diaphragm repair using posterolateral thoracotomy were applied to all three cases with an intraoperative diagnosis. There was a ruptured diaphragmatic cyst in only one case, while other cysts were intact and located in multiple organs. A preoperative diagnosis of diaphragmatic hydatid cysts is difficult, and standard treatment is surgery for all intrathoracic hydatid cyst cases.

Sudden Death Due to Hydatid Cyst

The natural history of the echinococcosis can be studded with multiple complications; the most formidable is sudden death. We studied the epidemiological, pathological, and thanatological features of 34 sudden deaths due to hydatid cyst. The mean age was 33.2 years. A male predominance was observed with a sex ratio of 1.8. Most of our victims were from rural areas (79.4%). Sudden death was preceded by prodromal symptoms in 61.7% of cases. The most common was dyspnea (23.5%), followed by hemoptysis (11.8%). In 85.3% of cases, the cyst location was liver. It was cracked in 25 cases and broken in 6 cases. The rupture was spontaneous in 25 cases (73%). It was preceded by trauma in 7 cases. Death was related to an anaphylactic shock in 82.3% of cases, infection in 14.7%, and respiratory distress in 3% of cases. Sudden death is a serious and not exceptional complication of hydatid cyst. Several mechanisms may explain the sudden death.

Complicated Pulmonary Hydatid Cysts

Complicated Pulmonary Hydatid Cysts

Complicated Pulmonary Hydatid Cysts

Complicated Pulmonary Hydatid Cysts

Complicated Hydatid Cysts of the Liver: A Report of Two Cases

The authors report two cases of complicated hydatid cysts of the liver, including one which was spontaneously broken in the bile ducts and the other fistulized in the right pleura. Patients presented with jaundice and biliary colic in the first case. Cough basithoracic pain, weakness, and fever in the second. Both patients were investigated by ultrasound and CT scan followed by a hydatid serology. In both cases the patients improved after surgical treatment. Will be recalled imaging aspects of these two complications.

How to manage the complicated hydatid cyst of the lung? Is any special surgical procedure more preferred?

Results 31.1% of cases were intact cysts and 68, 9% were complicated cysts. 34, 8% of intervened cases had complications, mainly air leakage (>7 days) but there were not fatal cases. The cases with preoperative complicated cysts had postoperative complications 1.6 times more than for cases with simple cysts but there is no statistical significance. The mean number of the hospitalized days for complicated cysts was (18.46±7.3) and the mean numbers of hospitalized days for intact cysts (14.7+5.4) that has a statistical significance. The major part of patients with complicated cysts (60%) had undergone an On Plat procedure, but there is no statistical significance between surgical method applied for preoperative complicated cysts concerning to postoperative complications.

Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach

The aim of this study was to assess the relationship between the pulmonary hydatid cyst size and the clinical presentation, surgical approach, and postoperative outcome. We review the problems encountered in treating large pulmonary hydatid cysts and highlight the risks associated with the rupture of the cyst and a delay of the surgical treatment. The medical records of 169 patients surgically treated for lung hydatid cysts were reviewed. Patients were divided into two groups based on cyst size: group 1 (n=128) with small (<10cm) cysts and group 2 (n=41) with giant (≥10cm) cysts. Data related to symptoms, preoperative complications, surgical procedures performed and postoperative morbidity were analyzed and compared. In both groups, the most common symptom was chest pain, followed by dyspnea and cough, respectively. There were no differences between the two groups with respect to cyst-associated parenchymal or pleural complications before surgery (p=0.80). In the large majority of cases, the surgical treatment was cystotomy, removal of the cystic membrane and capitonnage. Wedge resection was performed in nine patients in total (seven in group 1, two in group 2) and one patient in group 2 required a lobectomy. Decortication was required significantly more frequently in group 2 than in group 1 (p=0.001). Sixteen patients in group 1 and 10 patients in group 2 developed postoperative complications (p=0.19). There was no peri or postoperative mortality. There was no difference between the groups with respect to the duration of hospitalization (p=0.17). Two patients with complicated hydatid cysts in group 1 had recurrent lesions during follow-up, whereas there was no recurrence in group 2. All pulmonary hydatid cysts should be surgically treated as soon as possible after their diagnosis in order to avoid complications. Most of these lesions, regardless of size, can be surgically managed with procedures that preserve the maximal lung parenchyma and yield excellent outcomes.

Aspergilloma in a Pulmonary Hydatid

Aspergilloma infection in the lung can occur in preexisting cavities and is usually seen after tuberculosis, pulmonary infarction and bronchestasis. Occassionally aspergilloma has been reported within a hydatid cyst. We describe a patient with aspergilloma formed within cyst hydatid. The primary symptom in this patient was recurrent hemoptysis. In this 42-year-old male, the diagnosis was established by HRCT chest. Treatment consisted of postero-lateral thoracotomy with a bilobectomy of lower and middle lobe. Aspergilloma is an unusual complication of hydatid cyst and results from the deterioration of local defence against opportunistic infections.

Complicated Hydatid Cysts of The Lung

Complicated Hydatid Cysts of The Lung

Complicated Hydatid Cysts of The Lung

Introduction Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The organs most commonly affected are the liver and the lungs. Purpose The purpose of this study was to exhibit some characteristics of complicated pulmonary hydatidosis such as the clinical, radiological features and therapeutic option. Methods We retrospectively reviewed the medical and radiological records of patients who had hospitalized for complicated pulmonary hydatidosis at the center for Chest Diseases of Hedi Chaker hospital, Sfax, Tunisia, between 1 January 1993 and 31 December 2013. Results 29 cases (mean age = 36,4 years) were evaluated between 1996 and 2013. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (34,48%) and into the pleur in 13,7%. Extrathoracic involvement was found in 10,3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 80% of the patients. The Fibre-optic bronchoscopy allowed the extraction of hydatid cyst membrane in 10% of cases. Surgical treatment was performed in all cases. Medical treatment was associated in 5 cases. Outcome revealed recurrence of pulmonary hydatidosis in 1 patient, and the death of 1 patient with hemorrhagic shock. Conclusion Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and require pulmonary resections.