Diagnosis Of Hepatic Hydatid Cysts Research Articles

Efficacy of Preoperative Albendazole on Protoscoleces Viability in Hydatid Cyst of the Liver.

Optimal duration for medical therapy of liver hydatid cysts before surgery in not certainly defined yet. In this study, we aimed to evaluate the effectiveness of 2 weeks preoperative albendazole in decreasing viable cysts. Patients referring to Imam Reza Hospital, Mashhad, Iran with a diagnosis of hepatic hydatid cyst were randomly divided into intervention (44 patients) and control (46 patients) groups. The case group were treated with oral albendazole before surgery and the control group underwent surgery without albendazole therapy. Efficacy of albendazole on the reduction of prevalence and viability of the protoscoleces was finally evaluated. A number of 90 patients were included in the final analysis. Protoscoleces were reported alive in 10 (22.7%) and 17 (36.9%) of patients in the case and control group, respectively. The decrease of live protoscoleces in case group was not statistically significant (P=0.14). Decrease in the viability of protoscoleces in hepatic hydatid cysts after 2 weeks administration of oral albendazole at a dose of 10 mg/kg/day preoperatively, is not significant. Optimal duration of medical treatment before surgery seems to be 4 weeks or more.

Laparoscopic Management of Hepatic Hydatid Cyst at Bangabandhu Sheikh Mujib Medical University

Background: Laparoscopic management of hydatid cyst in the liver is now becoming popular with the introduction of modern devices like Pallanivelue Hydatid Cyst Cannula System that makes the procedure easier, safe, and acceptable. The laparoscopic approach is not only a cosmetic issue; it also prevents the recurrence rate by preventing spillage and complete removal of endocyst. Objective: Here we assess the Laparoscopic management of hydatid cyst in the liver of 30 cases at the Department of General Surgery. Methods: It is a prospective study having ages ranging from 18 to 65 years were included in this study, from April 2015 to March 2020. Laparoscopic endocystectomy was performed in all cases with deroofing of the cyst wall and observed the outcome of the procedure. All the cases were diagnosed clinically and confirmed by ultrasonography and CT scan. Results: A total of 30 patients, 13 males, and 17 were females. The most common presenting complaints were pain in the abdomen in 20(66.66 %), a lump in the right upper abdomen in 18(60 %), jaundice 2(10 %). Hepatic Hydatid cyst diagnosed by USG, CT scan, and serological test were included in this study. The distribution of cyst sizes was: 1-5 cm 3; 6-10 cm 8; 11-15 cm 10; > 15 cm 9 patients. Abdominal ultrasound and CT scan were done to confirm the diagnosis of hepatic hydatid cyst in all patients. The right lobe was involved in 25(83.33 %), left lobe in 4(13.33 %) with both lobes in 1(3.33 %). Intraoperative complications 5(16.66%). Per operative bleeding 1(3.33%), spillage 2(6.66%), and cystic biliary communication 2(6.66%). The main operating time was 95(60-120) minutes. The mean duration of hospital stay was 5.22(3-10) days. Conclusion: The laparoscopic cyst evacuation and omentoplasty using PHS are safe for treating the hydatid cyst of the liver in the selected patients, while addressing all the conventional surgical principles of treating the hydatid cysts, like aspiration, prevention of spillage, sterilization of cysts, and partial deroofing. It aids early recovery with good cosmetic results. PHS is an ideal method for single or multiple hydatid cysts of the liver with minimal complications and morbidity.

Results of Minimally Invasive Methods in the Treatment of Liver Hydatid Cyst

Objective: The most common cause of hydatid cyst disease is Echinococcus granulosus. Nowadays, minimally invasive methods such as laparoscopy used in the treatment of hepatic hydatid cyst (HHC). In this study, it is aimed to share the clinical, surgical and postoperative data of patients who underwent laparoscopic surgery with a diagnosis of HHC in our clinic.
 Methods: Data of 105 patients who underwent laparoscopic surgery for HHC between January 2011 and January 2020 were retrospectively analyzed. Patients who were diagnosed with HHC by clinical, indirect hemagglutination test, upper abdominal ultrasonography (USG) and upper abdominal tomography were included in the study. All patients received 10 mg / kg / day albendazole therapy for a total of six weeks, two weeks preoperatively and four weeks postoperatively. Demographic information, clinical characteristics, and the incidence and percentage of complications were analyzed by simple manual calculation.
 Results: 64 (60.95%) of 105 patients who underwent laparoscopic surgery were male and 41 (39.05%) were female. The mean age was 40.6 ± 11.7 years (18-65 age range). The mean cyst diameter was 8.4 cm in size (minimum: 6 cm, maximum: 16 cm). The mean operation time was 55 ± 11.45 minutes (Range: 42 to 70 minute). The mean hospitalization period of the patients was 3.7 days (Range 2 to 7). No recurrence was observed in the 18-month follow-up of the patients.
 Conclusıons: HHC is a common disease in our country, and we think that laparoscopic approach is an effective surgical treatment option in suitable patients and in experienced centers.

Various Presentations of Hepatic Hydatid Cystic Disease and their Management

Introduction Hydatidosis, a zoonotic infection, is due to the larval stage of the tapeworm Echinococcus (E.). Two of the recognised species, E. granulosus and E. multilocularis, are of importance for humans. The disease has a world-wide distribution. Biological diagnosis relies on serological tests. CT-scan of abdomen and chest, while not usually essential for diagnosis, gives a better definition of cysts content, number, size and calcification together with relation to vessels or other organs. With this information this study aims to analyze the different clinical presentations, complications and available various management options available for hydatid cyst of liver. Method & Materials This is a prospective observational study of 30 patients with hydatid cyst of liver included the patients admitted in the Department of General Surgery, L.L.R.M. Medical College, Meerut and S.V.B.P. Hospital, Meerut between jan 2018 to august 2018. All patients of either sex, male or female admitted with the diagnosis of hepatic hydatid cyst. There were no exclusion criteria. The data was analyzed by SPSS 21.0 version. Result In our series we analysed 30 patients. M:F ratio was 1.3:1. Most commonly involved age group was 40–49 yrs. Pain abdomen was the most common presenting symptom seen in 22 patients. Hepatomegaly was seen in 22 patients, Jaundice seen in 16 patients. Right lobe of liver was involve in 20 patients while both lobes were involved in 10 patients. Isolated left lobe involvement was not seen.ELISA for Echinococcal Antibody was performed in all 30 patients. Sensitivity was 100% while specificity was 99%. Deroofing with omentoplasty and wound drainage was the most commonly performed procedure and was performed in 12 patients Concluson This study was conducted to highlight the different modes of presentations of hydatid cyst of liver and effective management techniques. For symptomatic hydatid cyst of liver, open surgical approach is the best modality of management. Although majority of patients were treated surgically, importance of antihelminthics chemotherapy pre and post operatively is immense. As there are less number of patients presented in our study this data can be meta analyzed in other higher institutions.

Hepatic hydatid cyst - diagnose and treatment algorithm.

Introduction: the hydatic disease, caused by the larvae of Echinococcus granulosus, is a serious disease, potentially lethal, which can be found anywhere in the world, but especially in endemic areas such as the Mediterranean Basin, Australia, New Zealand, North Africa, Eastern Europe, the Balkans, Middle East and South America. The hydatic cyst is mainly found in the liver (75% of the cases), being asymptomatic in most cases and discovered accidentally on a routine abdominal ultrasound or an ultrasound performed for diagnosing other pathologies. The hepatic hydatid cyst therapy is multimodal, including medical, surgical, and, lately, minimally invasive techniques.Materials and methods: 88 patients were diagnosed with liver hydatid cyst at the General Surgery Clinic of the Colentina Hospital in Bucharest where they were admitted from January 2014 to July 2017. Data collection was realized by consulting the patients’ observation sheets, followed by organizing a database of clinical, paraclinical and treatment parameters. Age, gender, place of origin, year and duration of admission, symptoms and signs at admission, paraclinical serological tests relevant for liver function and E. granulosus infection, imaging investigations performed and their results, type of treatment received and post-treatment progress with the complications that occurred were taken in account.Results: some of the results of the study showed some differences comparing to the data from specialty literature, the possible causes being the small number of patients, the paraclinical examinations that were not sufficiently detailed to allow the study of a phenomenon in all its complexity, the lack of information from the patients’ first presentation to a doctor or from their previous admissions.Conclusions: patients with hepatic hydatid cyst form a heterogeneous group, semiology being poor and unspecific. Among the laboratory examinations, eosinophilia is a sign of concern but is present in less than half of the patients. Imaging findings are the basis for the diagnosis of hepatic hydatid cysts. Surgical treatment remains the “gold standard” in therapy, but minimally invasive methods with high applicability, less frequent complications and lower hospital requirements are starting to gain ground.

A Case of Echinococcosis: Surgical Management of Hepatic Hydatid Cyst

Echinococcosis is a parasitic infection, also known as hydatidosis, caused by of the tapeworm Echinococcus. In regions endemic to cystic echinococcosis the World Health Organization reports incidence rates over 50 per 100,000 person-years. It is globally distributed and commonly seen in regions with pastoral and rangeland areas. Humans are accidental intermediate hosts through ingesting food and water contaminated with the parasites eggs. The species Echinococcus granulosus causes cystic echinococcosis predominately affecting the liver. A 34 year old female Yemeni immigrant, presented with the chief complaint of right upper quadrant abdominal pain, and slightly elevated transaminases. An abdominal CT with contrast noted a 10.1 X 9.3 cm cyst in the superior right hepatic lobe. Using ultrasound guidance cyst 500 ml of colorless fluid was aspirated from the cyst. Cytology demonstrated parasitic structures with hooklets consistent with Echinococcus. She was treated with a 10 day course of Albendazole, however she continued to have persistent abdominal pain. Repeat CT and US revealed recurrence of the cyst with findings concerning for daughter cyst formation. Based on World Health Organization staging criteria treatment options included; repeat cyst aspiration or surgical resection with concomitant Albendazole. In light of the cystic septations noted on MRI surgery was favored and she underwent hepatic segment VII resection with the encapsulated cyst. She had an uneventful recovery with normal hepatic function and was discharged home with 4 weeks of albendazole therapy. Repeat ultrasound 2 months post op revealed no evidence of recurrent cyst formation. The diagnosis of hepatic hydatid cysts requires a high degree of clinical suspicion and knowledge of the subtle signs and symptoms of the disease. Early diagnosis and appropriate treatment prevents complications of the disease including pressure symptoms, cyst leakage, cholangitis and anaphylaxis. Treatment options are dependent on the stage of the hydatid cysts, and surgery should be considered for patients who have not responded to medical management and have evidence of cyst criteria not amenable to percutaneous drainage. Rates of recurrent infection are significantly lower after radical surgical procedures however follow up is still recommended for up to 5 years post treatment with periodic imaging.Figure: Cut sections of the single hepatic cyst with multiple concentric membranes and yellow scoleces.Figure: Admission CT abdomen and pelvis with contrast shows right hepatic lobe cyst measuring 10.1 x 9.3 cm.Figure: MRI w contrast demonstrating the floating membranes.

The study of biochemical profile of cyst fluid and diffusion-weighted magnetic resonance imaging in differentiating hepatic hydatid cysts from liver simple cysts.

PurposeThe aim of this study was to investigate the value of biochemical profile of cyst fluid and diffusion‐weighted imaging (DWI) in differentiating hepatic hydatid cysts (HCs) from liver simple cysts.Materials and methodsForty‐six patients underwent MR imaging. Twenty‐nine patients had 29 hydatid cysts and 17 patients had liver simple cysts. Thirteen patients with hydatid cysts and seven patients with liver simple cysts were evaluated with cyst fluid biochemical analysis. The concentration of glucose, protein, calcium ion (Ca2+) electrolyte, macroscopic appearance, and parasitological sediment were evaluated in this study.ResultsIn the respect of biochemical analysis cyst fluid, the concentration of glucose and calcium ion of HCs was significantly higher than that of the liver simple cysts. In the respect of DWI, in the b 1000 s/mm2 value in respect of mean application data center (ADC) values, there was a statistically significant difference between HCs group (the mean value was (2.50±0.79)×10−3 mm/s2) and liver simple cysts group (the mean value was (2.92±0.66)×10−3 mm/s2). However, no statistically significant results were obtained in the ADC measurements of b 500 s/mm2 between two groups.ConclusionThe analysis of cyst fluid combined with the measurement of ADC values in the b 1000 s/mm2 value could be considered a promising parameter as an alternative to the differential diagnosis of hepatic hydatid cysts from liver simple cysts.

Comparative biochemical, parasitological, and histopathological studies on cystic echinococcosis in infected sheep

Hydatid disease is a foremost public health and economic problem causing morbidity and mortality. This study was done to investigate the parasitological studies and biochemical and histopathological changes of hydatid cyst infection in livers of sheep. Our study was carried out prospectively on sheep slaughtered in a southern slaughterhouse, Hail city, conducted from January 2015 to December 2015 to determine the prevalence, cyst viability, and biochemical analysis of fertile and infertile hydatid fluids. Out of 53,981 slaughtered sheep, 3811 were found infected with hydatid cyst; specifically, hydatid cyst was detected in the liver of sheep. The overall infection rate in slaughtered sheep in this period (from 1 January 2015 to 30 December 2015) was 7.06%. The fertility rate of 330 examined hydatid cysts selected from the overall slaughtered sheep was observed to be 18.18%. Hydatid cyst fluid collected from fertile cyst had high levels of calcium, phosphorus, potassium, chloride, iron, and alkaline phosphatase activity but a low level of sodium, glucose, cholesterol, triglycerides, and total protein as compared to infertile hydatid fluid. Sections from infected liver showed distinct hydatid cyst structures and fibrous tissue; also, hepatic tissue showed necrosis of variable degrees. The prevalence of cystic Echinococcus in Hail area was at an overall rate of 7.06% and the majority of cysts in sheep were infertile. Additionally, biochemical analysis of HF could be helpful for the diagnosis of hepatic hydatid cysts which have a deleterious effect on morbidity and mortality in sheep.

Hepatic hydatid cyst.

A 58-year-old man was admitted for the evaluation of an incidentally detected hepatic mass. Intravenous contrast-enhanced abdominal computed tomography scan in conjunction with contrast-enhanced T1-weighted magnetic resonance imaging (MRI) showed a smooth-margined cyst in the left lateral hepatic segment, which measured 8.5 cm in diameter at the widest point, and contained several other small cysts. There was also another sizable cyst in right hepatic lobe, measuring roughly 3.3 cm in diameter, with a small calcification along the wall (Fig. 1). T2-weighted MRI showed additional small low signal intensity tubular lesions within the large cyst (Fig. 2). Figure 1 Contrast-enhanced abdominal computed tomography scan shows a smooth-margined large cyst in left lateral hepatic segment (white arrow), containing several small daughter cysts (arrowheads) and another cyst in the right hepatic lobe, with a small calcification ... Figure 2 T2-weighted magnetic resonance imaging shows a high signal intensity large cyst containing multiple smaller bright signal intensity cysts, and a few small hypointensity tubular lesions (arrows). At the time, the patient's laboratory findings, including white blood cell count, differential eosinophil count, C-reactive protein, and liver function test, were within normal range. He often ate canine flesh and pork; however, his stool examination was negative for parasite egg. The patient underwent left lateral hepatic sectionectomy and right hepatic tumorectomy. The gross morphology of the large cyst in the left lateral hepatic segment showed fibrotic material, several small gelatinous fluid collections, serous fluid, and a few small dead tubular worms. They were identified pathologically as Echinococcus granulosus. The other cyst in right hepatic lobe was also considered as a hepatic hydatid cyst. Echinococcosis in humans is a zoonotic secondary infection by the larval stages of the cestode species of the genus Echinococcus. Cystic echinococcosis (CE) is caused by E. granulosus. The intermediate host, humans, enter the organism's life cycle through exposure to infected canine feces. If the cyst contains a living worm, peripheral eosinophilia can be frequently seen. The liver is the most common organ of CE. In the case of hepatic CE, the right hepatic lobe is more frequently involved, and the morphological form, about 75% of cases, is a unilocular simple cyst. However, a large mother cyst containing multiple small daughter cysts in the liver is considered relatively typical and highly specific imaging finding for the diagnosis of hepatic hydatid cyst. In this case, there were a few small tubular structures within the cyst on MRI were regarded as dead worms in the pathologic specimen. A second cyst with a small calcification is non-specific imaging finding. In the presented case, it was another hepatic hydatid cyst. According to the classification of a hepatic hydatid cyst, a cyst with calcification is considered a dead cyst.

Evaluation of ultrasonography as a diagnostic tool for hepatic hydatid cysts in sheep

This retrospective study was designed to evaluate the use of ultrasonography for the diagnosis of hepatic hydatid cysts. This study was conducted on 22 sheep, which were classified into 2 groups according to their liver health group (healthy liver = 13 and cystic liver = 9). Biochemically, serum concentrations of gamma-glutamyl transferase, aspartate aminotransferase, total bilirubin, and globulins were significantly increased (P < 0.01) while albumin was lowered (P < 0.01) in sheep with cystic livers. Ultrasonographically, rounded, anechoic, and unilocular hydatid cysts with elliptical circumferences ranging from 6 to 10 cm were seen. The interiors of cysts contained echogenic particulate materials, septations, or fine echoes. At the 10th intercostal space (ICS), ventral margin, size, thickness, and angle of livers increased in sheep with hepatic cysts, while the diameter of portal vein decreased in sheep with liver cysts. At the 9th ICS, the circumference of the gall bladder was lowered in sheep with hepatic cysts (P < 0.01). The sensitivity, specificity, and positive and negative predictive values of ultrasonography for diagnosis of hepatic hydatid cysts were 80%, 100%, and 100% and 83%, respectively. In conclusion, ultrasonography alone or in combination with some biochemical parameters reflecting liver function could be helpful for the diagnosis of hepatic hydatid cysts in sheep.

Ultrasonographic features of the liver with cystic echinococcosis in sheep.

ObjectivesThe present study was designed to gain information about the ultrasonographic features of livers with cystic echinococcosis, as well as to evaluate the use of ultrasonography for diagnosis of such disease in sheep.DesignThis was a retrospective study during the period April 2011 to March 2013.ParticipantsA total of 22 Baladi sheep (aged three to six years) were included in this study. Based on clear hepatic ultrasonographic findings, all animals were classified into two groups: those with hepatic cysts (n=9) and without liver cysts (healthy liver, n=13).ResultsBiochemically, serum concentrations of γ-glutamyl transferase, aspartate aminotransferase, total bilirubin and globulins were significantly increased (P<0.01), while albumin was lowered (P<0.01) in sheep with cystic livers. Ultrasonographic findings of diseased sheep livers revealed the presence of rounded, anechoic and unilocular hydatid cysts with ellipse circumference ranged from 6–10 cm. The borders of cysts were mostly well defined. The interior of cysts contained echogenic particulate materials, septations, or fine echoes. At the 10th intercostal space, the ventral margin, size, thickness and angle of livers were higher (P<0.01), while the diameter of portal vein was lower (P<0.01) in sheep with liver cysts than control ones. Furthermore, at the 9th intercostal space, the circumference of the gall bladder was decreased in sheep with hepatic cysts (P<0.01). The sensitivity, specificity, and positive and negative predictive values of ultrasonography for diagnosis of hepatic hydatid cysts were 80 per cent and 100 per cent, and 100 per cent and 83 per cent, respectively.ConclusionsCystic echinococcosis is associated with a number of anatomical alterations in the liver tissues that can be easily recognised by ultrasound. Furthermore, ultrasonography alone or in combination with analysis of biochemical parameters reflecting liver function could be helpful for diagnosis of hepatic hydatid cysts in sheep.

Microscopic Image of the Protoscolex of Echinococcus granulosus on the “Hydatid Sand”

An 8-year-old child originally from Morocco spent 1 month in Spain before complaining of abdominal pain for the previous 24 hours. There was no fever, vomiting, or diarrhea. He had lived in a rural area with dogs and sheep. Physical examination detected a mass in upper-right abdominal area. Chest X-ray showed right hemidiaphragmatic elevation. Ultrasonography showed a hypoechoic cyst mass of 12.5 × 10.5 × 8.5 cm without septum or calcifications that was a type CE1 according to the World Health Organization standardized classification.1,2 Computed tomography (Figure 1) and magnetic resonance imaging confirmed the diagnosis of hepatic hydatid cyst. Invasion into the biliary tree bile ducts, portal vein, or hepatic vein was not seen. IgE-specific serology for Echinococcus granulosus was positive (18.3 kUI/L). Serology for Entamoeba histolytica was negative. Aspartate and alanine amino transferase levels were increased (145 U/L and 151 U/L, respectively). Treatment with albendazole was initiated, and cystectomy was performed on the 18th day after admission. Gross examination showed hydatid sand; the protoscolex of E. granulosus was seen by light microscopy (Figure 2). Albendazole was maintained for 3 months and discontinued when ultrasound and serology confirmed resolution. The patient remained asymptomatic on follow-up visits. Figure 1. Image from a computed tomography study of the abdomen of the patient. Figure 2. Hydatid sand containing a protoscolex of Echinococcus granulosus was seen by light microcopy. This figure appears in color at www.ajtmh.org.

Diagnosis of Hepatic Hydatid Cysts by Splenoportography

Diagnosis of Hepatic Hydatid Cysts by Splenoportography