Hepatic Hydatid Cyst Research Articles

Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers

Objective: Intrabiliary rupture or cystobiliary fistula is the most common complication of hepatic hydatid cyst. In this article, our objective is to evaluate the clinical, laboratory, imaging, surgical treatment and results of cystobiliary fistulas, which is the most common complication of hydatid cysts. Material and Method: In our study, patients who underwent open surgery and were followed up and treated for hydatid cyst in the gastroenterology and general surgery outpatient clinic and service between years 2015-2021 were included. The clinical, laboratory, radiological and surgical results of 171 patients with hydatid cysts were retrospectively analyzed. Results: The mean age of 171 patients who underwent surgery for hydatid cyst was 44.8 (18-71), 68 of whom were men and 103 were women. Bile leakage was present in 50 patients (50 (29.23%)). There were 24 (48%) men and 26 (52%) women with bile leakage. The cyst diameter was 74.2 (36-170) mm and the number of cysts was 1.2 (1-2). The cysts were located in the right lobe of the liver in 116 (79%) patients, in the left lobe in 30 (15%) patients, and in both lobes in 25 (6%) patients. Cystobiliary fistula developed more frequently, especially in cysts located in the right lobe(36 (72%)). Cystobiliary fistula was most common in CE3 (Gharbi type 2) type (30 (60%)). Cystectomy+drainage was performed in 137 (80%) patients in all groups. Cystectomy and drainage were the most common surgical procedures. The cyst diameter was 10 cm in the group with cystobiliary fistula and was significant compared to the group without fistula (p<0.001). Aminotransferase (AST and ALT) levels were high in patients with cystobiliary fistula (p=0.012, p=0.054). However, there was no significant difference between the two groups in alkaline phosphatase, total bilirubin, and gamma glutamyl transferase (p=0.231, p=0.097, p=0.544). Conclusion: Liver hydatid cyst is endemic in our country as well as in many other countries in the world. Complicated hepatic hydatid cysts require timely and appropriate treatment because of their life-threatening complications. Cytobiliary fistula is the most common complication. In the surgical treatment of hydatid cyst disease, the earlier the diagnosis of occult cystobiliary fistulas is made (especially in the preoperative or peroperative period), the easier the treatment is, and the risk of bile leakage and consequently the morbidity and mortality decreases. Our results and experience showed that treatment and complications are related to the location and size of the cyst, occult/large cystobiliary fistula, detectability of occult fistulas, experienced center and surgeon.

Pre- and postoperative diagnostic of giant hepatic hydatid cyst: a case report and brief literature review

Pre- and postoperative diagnostic of giant hepatic hydatid cyst: a case report and brief literature review

Cholecysto-Hydatid Cyst Fistula: Images in Medicine

Human hydatid disease is a zoonosis caused by the larval stage of the Echinococcus species. It is endemic in sheep and cattle raising region such as Morocco. The liver is the most frequently affected organ in echinococcosis (first filter). Cyst rupture into the biliary tree is the most common complication of hepatic hydatid cyst, seen in 5% to 15% of cases. However, fistulization between gallbladder and hydatid cystis rare. The number of cases in the literature is below 10 [1].

Robot-assisted pericystectomy using Da Vinci Xi surgical system with indocyanine green fluorescence imaging for hepatic cystic echinococcosis

The clinical efficacy of robot-assisted laparoscopic pericystectomy using the Da Vinci Xi surgical system plus indocyanine green（ICG） fluorescence imaging and the conventional laparotomy for en bloc pericystectomy was compared. The clinical data of 7 patients treated by robot-assisted laparoscopic pericystectomy using the Da Vinci Xi surgical system plus ICG fluorescence imaging at our hospital between October 2019 and July 2021 and 15 patients treated by conventional laparotomy for en bloc pericystectomy were retrospectively analyzed. Compared with the conventional laparotomy group, the intraoperative blood loss was reduced using the Da Vinci surgical system [(225.43±44.75)ml: (521.33±246.34) ml, P=0.015]. The indwelling time of the urinary catheter was also shorter [2.86±0.75)d: (3.87±0.81)d, P=0.012]. However, the total expense was increased significantly [(49.9±3.7) thousand RMB: (28.7±5.0) thousand RMB, P<0.001]. The two groups of patients were not significantly different in operation time, time to flatulence after surgery, time to eat a liquid diet after surgery, length of hospital stay after surgery, time to drainage tube removal, and the incidence of postoperative complications (P=0.899). Both two groups were followed up for 3-12 months after surgery. The patients were generally good without recurrence or intra-abdominal implantation. The Da Vinci Xi surgical system could be feasibly and safely applied to the robot-assisted laparoscopic pericystectomy plus ICG fluorescence imaging for Hepatic cystic echinococcosis(HCE). This procedure could effectively remove the hepatic hydatid cysts under the ICG fluorescence imaging with a higher resection rate, causing less trauma and fewer complications.

Management of Incidental Rupture of Abdominal Hydatid Cyst

Abdominal hydatid cyst rupture is one of the critical situations which challenged the surgeon incidentally during explorative lobotomy for acute abdominal conditions. It is considered an endemic area for hydatid disease. To study and evaluate different modalities of surgical treatments used to deal with the incidental rupture of abdominal hydatid cyst. Patient and methodology: Patients (n=200) underwent surgical treatment for abdominal hydatid cysts in Al -Kindy teaching Hospital and Diala private hospital. A review was carried out from January 1996 to January 2006. About 18 patients (6%) had a rupture of abdominal hydatid cyst; in 15 patients (83.3%), the rupture was discovered incidentally during surgery for urgent acute abdomen, and 3 patients (16.7%) were detected clinically and using ultrasound. The median age was 32 years, and the female to male ratio was 2:1. 17 patients presented with signs &amp; symptoms of acute abdomen. 11 patients presented with hypovolaemic shock after trauma to the liver (RTA in 9 patients, anaphylactic shock in 1 patient, allergic reaction in 1 patient). 4 patients presented with spontaneous rupture, 2 presented with secondary hydatidosis, and 1 presented with haematuria. Results: Twelve females and six males were affected. Rupture of abdominal hydatid cyst was diagnosed in only three patients by history, clinical examination, and ultrasound. At the same time, the other 15 patients were diagnosed during surgery. The mean hospital stay was 14 days. About 5 patients developed post-operative complications, i.e., wound infection (n=1), stress ulceration in the duodenum (n=1), subphrenic abscess (n=1), an infected remnant of hepatic hydatid cyst cavity (n=1), and recurrence of the hydatid cyst (n=1). Unfortunately, intra-operative mortality was recorded in 1 patient. The clinical diagnosis is usually tricky, but ultrasonography is an excellent initial diagnosis in suspected cases. Keywords: Surgical treatment, Incidental Ruptured Abdominal hydatid cyst, Traumatic rupture.

Renal Hydatid Cyst Mimicking Renal Cell Carcinoma; A Case Report

Renal hydatid cyst is a rare entity as compared to hepatic hydatid cyst. However, literature manifests case reports of renal hydatid cysts. The establishment of diagnosis becomes difficult in non-endemic areas. The tumour is well-considered on clinical examination and radiological investigations for this condition. We presented a case of renal hydatid cyst in a 45-yearsold male patient who presented with hematuria and was labelled as renal cell carcinoma clinically and radiologically. However, histopathology confirmed the diagnosis of renal hydatid cyst.

Hydatid cyst of the liver fistulized into the inferior vena cava.

IntroductionFistulization or rupture of hydatid liver cysts to the inferior vena cava (IVC) is an extremely rare and life-threatening condition.Presentation of caseWe report the case of a 70-year-old patient who presented with right-upper-quadrant pain and fullness evolving for 03 months. Physical examination showed dilated veins over the anterior abdominal wall and the flanks associated with lower-extremity swelling. Computed tomograph of the abdomen showed a hydatid cyst invading segments VI and VII of the liver fistulized into the inferior vena cava. The IVC was partially trombosed. The diagnosis of a possibly ruptured hydatid cyst in the inferior vena cava was then made. The patient underwent surgical management. Per-operatively the cystic cavity had bloody content but the cysto-vascular communication was not identified. Partial cystectomy was performed leaving a fairly extensive contact between the calcified pericyst and the IVC. The postoperative course was uneventful.DiscussionRupture of the hepatic hydatid cyst into the IVC is very rare and may lead to fatal pulmonary embolism secondary to the migration of vesicles in the pulmonary artery or haemorrhagic shock. CT scan remains the best investigation method to assess the vascular links of the hepatic hydatid cyst especially with the IVC. Surgical treatment of the hepatic hydatid cyst ruptured into the IVC mandates vascular control before the hydatid cyst is punctured or removed.ConclusionFistulized hydatid cysts into the IVC should be operated on in centres equipped for extracorporeal bypass techniques, and experienced in the surgery of hepatic echinococcosis.

Laparoscopic management of hydatid cyst of liver

Background: Hydatic disease is caused by a parasite named Ecchinococcus granulosus. This disease is endemic in Pakistan. The disease mostly affects liver forming cysts. The treatment is mainly surgical which can be performed laparoscopically. This study was thus designed to assess the outcomes of the laparoscopic treatment of hydatid cyst of liver in terms of recovery of patient, complications and recurrence.Subjects and methods: This case series was conducted from March 2015 to December 2020 in Surgical Department of Services Institute of Medical Sciences Lahore. Patients who were planned for laparoscopic surgery for hepatic hydatid cysts (CE2, CE3) were included in the study. Patients who have past history of hepatobiliary surgery, with multiple small cysts or those who has refused for laparoscopic surgery were excluded from study. Demographic data, presenting symptoms, clinicopatholigical findings, duration of surgery, hospital stay and complications were recorded on pre-designed Performa. Results: Total of 42 patients were managed laparoscopically for hydatid liver cyst. The mean age of the patients was 39.42 + 12.04 years. There were 20 (47.62%) male and 22 (52.38%) female patients. Thirty patients (71.43%) were from rural areas. Twenty patients (47.62%) had history of close contacts with dogs or domestic animals. Patients mostly presented with symptoms of pain in right hypochondrium and abdominal mass. Majority of the patients had single hydatid cyst in the liver. Right lobe of the liver was more frequently involved than left lobe. Both lobes were involved in 2 (4.8%) patients. The mean duration of surgery was 76 minutes. No patient developed intra or postoperative anaphylactic shock. Biliary leakage was seen in 4 (9.5%), port site infection in 2 (4.8%) patients and conversion to laparotomy was done in 2 patients (4.8%). The mean hospital stay of patients was 3.41+ 2.82 days. There was no mortality of the patients or recurrence of cyst on 12 week follow up.Conclusion: Laparoscopic surgery for hepatic hydatid cyst is safe and effectual treatment in carefully selected patients. It is a simple technique with lesser postoperative morbidity and potentially decreased risk of complications especially recurrence of disease.

A rare case of hepatic hydatid cyst: Case report

A rare case of hepatic hydatid cyst: Case report

Liver transplantation due to hepatic hydatid cyst surgery: Not expected but possible

Liver transplantation due to hepatic hydatid cyst surgery: Not expected but possible

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; &gt; 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.

Postoperative morbidity risk factors after conservative surgery of hydatic cyst of the liver: a retrospective study of 151 hydatic cysts of the liver

BackgroundThe purpose of the present paper is to assess the morbidity specifics risk factors of hepatic hydatid cyst after conservative surgery.MethodsWe conducted a retrospective study of 102 patients over a period of 13 years, from 2006 to 2019. We included all patients operated on hydatid cyst of the liver, complicated and uncomplicated, in the Department of General Surgery in Tahar Sfar hospital, Mahdia, Tunisia. We excluded patients who received an exclusive medical treatment and those who have other hydatic cyst localizations.ResultsThe cohort was composed of 102 patients with a total of 151 cysts operated on using conservative surgery, among them there was 75 women (73.5%) and 27 men (26.5%). The median age was 43, with extremes ranging from 12 to 88 years. The majority of patients (94.1%) were from rural areas. The cysts were uncomplicated in about half of the cases (48%), elsewhere complications such as compression of neighboring organs (25.5%), opening in the bile ducts (16.7%), infection (9.8%), and rupture in the peritoneum (2%) were found. Conservative surgery was the mainstay of treatment with an overall mortality rate of 1.9%. The overall morbidity rate was 22%: 14% specific morbidity and 8% non-specific morbidity. External biliary fistula was the most common postoperative complication (9%). The predictive factors of morbidity in univariate analysis were: preoperative hydatid cyst infection (P = 0.01), Compressive cysts (P = 0.05), preoperative fever and jaundice, (respectively P = 0.03 and P = 0.02), no one achieved statistical significance in the multivariate model.ConclusionsPreoperative hydatid cyst infection, compressive cysts and preoperative fever and jaundice could be predictor factors of morbidity after conservative surgery for liver hydatid cyst. They must be considered in the treatment and the surgical decision for patients with hydatid cyst.

Pericardial, pulmonary and hepatic hydatid cyst

Pericardial hydatid cyst without cardiac involvement is extremely rare even in endemic countries [ 1 ], it results from the development of the larval form of Echinococcus granulosus tapeworm. Only 2–10% of cardiac echinococcosis are characterized by a pericardial cyst formation [ 2 ]. Clinical presentation usually regroups dyspnea, weakness, unexplained weight loss. When the localization of the cyst is cardiac, the occurrence of tamponade with fatal outcomes may occur if not treated early [ 3 ]. Diagnosis is based on imaging data and assisted by serology. The treatment often combines surgical procedures with medical therapy with albendazole [ 4 ]. The pericardial location makes the surgical treatment more challenging. . We report the clinical observation of a 5 years old operated child. We present the case of a 5 year-old boy whose parents sought medical attention due to dyspnea and abdominal mass.

Anaphylactic shock following minor abdominal trauma as the initial presentation of Echinococcus cyst: a case report

BackgroundAnaphylaxis is a potentially life-threatening condition caused by a variety of triggers. However, anaphylaxis following an abdominal trauma is an exceptionally rare condition and could be the first and only sign of hepatic hydatid cyst, especially when no obvious etiology is present. Here, we present such a rare case and discuss relevant diagnostic and management strategy in light of the literature.Case reportThis case report refers to a 17 year-old previously healthy girl admitted in our pediatric emergency department (ED) for syncope after a minor blunt abdominal trauma. She was hypotensive on admission and shortly after she developed urticaria and angioedema. She was diagnosed with anaphylaxis and treated immediately. Possible etiologies including drug or food ingestion, insect bite, and previous allergy/anaphylaxis history were excluded. After stabilization abdominal imaging was performed, which revealed a ruptured large hepatic hydatid cyst in the vicinity of biliary tree. Albendazole treatment was started and surgical resection was performed after clinical stabilization, which confirmed the cyst rupture into the biliary ducts. Patient recovered without complications after surgery and was discharged uneventfully.ConclusionThis case report highlights that hydatid cyst rupture should be included in the differential diagnosis of anaphylaxis without obvious etiology, particularly in regions where hydatid disease is endemic. Ruptured hydatid cyst leading to anaphylaxis requires timely diagnosis, management and emergent intervention.

Minimally invasive treatment of hepatic hydatid cysts complicated by the rupture into the biliary tract

The paper presents the clinical observations of the rare complication of hepatic hydatid disease: the rupture of hydatide cysts into the bile ducts. The complication causes obstruction of the bile ducts, obstructive jaundice, and cholangitis. The basic stages of diagnosis and the role of ultrasound in detecting the complications of hepatic hydatid disease have been highlighted in this paper. The minimally invasive percutaneous and endoscopic techniques under radiological guidance have been reviewed.

Pulmonary Artery Embolism Due to a Ruptured Hepatic Hydatid Cyst Into the Inferior Vena Cava: Clinical and Radiologic Imaging Findings

Background and Aim: Pulmonary embolism because of hydatid cysts is a very uncommon and lethal complication caused by a hydatid heart cyst rupture or a visceral hydatid cyst released into the venous circulation. By utilizing contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), hydatid pulmonary embolism can be differentiated from other types of pulmonary embolism. MRI mainly displays the cystic nature of lesions better than CT. Pulmonary embolism should be kept in mind in patients with hepatic hydatidosis if there is a sudden occurrence of chest pain and dyspnea, particularly in regions where hydatidosis is endemic. This report aims to present the clinical and radiographic features and discuss the diagnosis and treatment procedure of our patient. Case Presentation: Here, we report a 45-year-old man with pulmonary embolism as a consequence of a ruptured hydatid liver cyst in the inferior vena cava. Multiple intra-arterial pulmonary hydatid cyst emboli originating from a hepatic hydatid cyst ruptured into the hepatic portion of the inferior vena cava were seen in our patient. The patient refused the surgical treatment. Therefore, the patient was treated using Andazol (Albendazole) and Cetirizine hydrochloride. Conclusion: The present case is interesting because pulmonary embolism caused by hydatid cysts is a very uncommon clinical entity. There may be difficulties in diagnosing and treating hydatid cysts, and a definitive diagnosis was possible only by a histopathological examination.

Alveolar echinococcosis located in the liver: Report of a case

Echinococcosis is a parasitic infection caused by larval and cyst stages of Echinococcus granulosus living in dogs in humans. The definitive host of the parasite is dog, intermediate hosts are sheep, cattle and humans. The causative pathogen is mostly Echinococcus granulosus. Echinococcus multilocularis (alveolaris) and other agents are less common. Only 3% of hepatic hydatid cysts are alveolar hydatid cysts. In this study, we aimed to present a case of Alveolar echinococcosis located in the right lobe of the liver due to Ecinococcus alveolaris, together with the operation images. We evaluated the preoperative, peroperative and postoperative course of a patient who was examined with abdominal pain in our clinic and in radiological and serological examinations, we found an alveolar hydatid cyst located in the liver and underwent surgery. Our patient was a 31-year-old female. She applied for abdominal pain. Ultrasonography revealed a cystic mass of approximately 17 cm in diameter in the right lobe of the liver. In laboratory examinations, the hydatid hemagglutination test was positive at a titer of 1/2560. Hematological and biochemical parameters were normal. MRI showed a 171*125 mm sized, lobulated, locally calcified cystic mass in the right lobe of the liver. After evaluating the relationship of the lesion defined in CT angiography imaging with vascular structures, the decision to operate was made with the diagnosis of Alveolar echinococcosis.. Nonanatomical segmental right hepatectomy and total cyst excision operation was performed in our patient who was thought to have Alveolar echinococcosis based on clinical, serological and radiological findings. The patient, who had an uneventful postoperative period, was discharged on the 7th postoperative day with full recovery. In cases of echinococcosis, the treatment is determined according to the type of the agent, the stage and localization of the lesion. Medical treatment, PAIR and surgery are the treatment options that can be applied. Total excision of the mass is recommended in cases of Alveolar echinococcosis.

Ruptured hepatic hydatid cyst causing cholangitis

Ruptured hepatic hydatid cyst causing cholangitis

Ruptured hepatic hydatid cyst with the formation of an abscess and a cutaneous fistula

Ruptured hepatic hydatid cyst with the formation of an abscess and a cutaneous fistula

PAIR. Percutaneous Treatment of Hepatic Hydatid Cyst: A Case Report

Cystic Hydatidosis is a zoonosis caused by the Echinococcus Granulosus. The most affected solid organ is the liver (70% -80%). The best treatment, surgery, percutaneous drainage or medical treatment (albendazole) has not yet been defined, and in all cases, the individuality of each patient (age, comorbidities, size and location of the cyst) must be taken into account. In 1985, QHH puncture was published as a therapeutic option. Since then, PAIR treatment (puncture, aspiration, instillation of scolicide and re-aspiration) has established itself as a valid treatment.