Percutaneous Treatment Of Hydatid Cysts Research Articles

Abscess and bronchobiliary fistula following percutaneous hydatid cyst treatment: A case report

Hepatik kist vakalarinin cogu komplike olmayan klinik seyir ve tedavi gostermektedir. Perkutan mudahale edilen kistlerde, kist icerisindeki basincin dusmesi ile gizli olan safra fistulleri kavite icerisine drene olabilir ve kist komplike hale gelebilir. Komplike hale gelmis olan kistler non invaziv ve minimal invaziv yontemlerle takip ve tedavi edilebilir. Ancak kistin yerlesim yeri, buyuklugu ve hastanin yasadigi yer goz onunde bulundurularak yakindan takip edilmesi gerekir. Perkutan mudahale edilen ve apse gelismis kist hidatiklerde cerrahi tedavide gec kalmak, yuksek morbidite ve mortalite oranlarina neden olmaktadir. Karaciger sag lopta 150x110 mm ebadinda Gharbi tip 1 kist hidatik lezyonu olan hastaya ultrasonografi esliginde PAIR (puncture – aspiration – injection – respiration) yapilmisti. Kistin safra yollari ile istirakli olmasi uzerine perkutan kateter takilmis ve endoskopik retrograd kolanjiopankreatografi (ERCP) yapilmisti. Takiplerinde kavite enfeksiyonu gelismesi uzerine acik cerrahi drenaj yapilan, ameliyattan sonra bronko-bilier fustul ve pnomoni gelisen Kist hidatik olgusu sunulmustur. Perkutan tedaviye bagli kavite enfeksiyonu gelisen hastalarin, hastanede kalis suresi, tedavi maliyetleri ve hastaligin morbiditesi acik cerrahi yapilan hastalara gore daha kotu sonuclara yol acmaktadir. Kavite enfeksiyonu gelisen hastalarin yakin takip edilmesini ve gecikmeden cerrahi islem yapilmasinin daha uygun oldugunu dusunuyoruz.

A Serious Complication of Percutaneous Treatment of Hydatid Cycts: Bile Fistula and Ischemia of Liver

Echinococcosis is a zoonotic, cyst-forming parasitic disease of worldwide distribution caused by the larval stage of the Echinococcus. When left untreated, grow and follow one of several courses such as fistulae with adjacent organ or biliary system, rupture into the peritoneal cavity caused anaphylaxis, rupture into peritoneal cavity seeding daughter cysts. PAIR (percutaneous aspiration, irrigation with scolicide and respiration) has been utilized safely an effectively in selected patients. But rarely, a complication of PAIR can be life-threatening. Therefore, PAIR should only be performed in centers with appropriate medical and surgical modalities. We present a case of percutaneous treatment of hydatid cyst with a serious complication: biliary fistula and hepatic ischemia.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

AIMTo comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease.METHODSTrocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays.RESULTSThe positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively).CONCLUSIONThere are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

Refractory Cystobiliary Fistula Secondary to Percutaneous Treatment of Hydatid Cyst: Treatment with N-Butyl 2-Cyanoacrylate Embolization

A 27-year-old female with a type 2 hydatid cystic lesion in the liver according to the Gharbi classification (CE 3A according to the WHO classification) was referred for percutaneous treatment after albendazole treatment for 1 year. A catheterization technique was performed but hypertonic saline and alcohol were not given into the cavity due to cystobiliary leakage. During the 4-month follow-up period, sequential cavitography revealed biliary fistula, and bile-stained drainage had not been ceased despite the sphincterotomy, nasobiliary drainage catheter, and plastic stent. Since the patient refused to surgery, we embolized the biliary fistula using N-butyl 2-cyanoacrylate for the first time in the literature. At the 3-month follow-up, the patient's course was uneventful and ultrasound, multidetector-row CT, and MRI examinations revealed no collection in or adjacent to the cavity.

Long-Term Follow-Up of the Percutaneous Treatment of Hydatid Cyst in the Adrenal Gland: A Case Report and Review of the Literature

Although the most involved organs are liver and lung, hydatid cysts occur in adrenal glands, rarely, and constitute only 0.5% of hydatid cysts. Herein, we demonstrate and discuss, for the first time in the literature to the best of our knowledge, the radiological features of adrenal hydatid disease and evaluate the long-term results (57 months of follow-up) of the percutaneous treatment of hydatid cyst in the adrenal gland in a patient.

Percutaneous treatment of hepatic hydatid cyst in pregnancy: long-term results

To present the long-term results of percutaneous treatment of hepatic hydatid cyst in pregnancy. Six pregnant patients (age range 19-28 years; mean age 23 years) with six hepatic hydatid cysts underwent percutaneous treatment without albendazole prophylaxis. Puncture, aspiration, injection and reaspiration (PAIR technique) were used to treat the cysts. Hypertonic saline solution was used as cytotoxic agent. Follow-up was mainly by sonography every 2 weeks during pregnancy, every third month post-partum for the first year, every 6 months for the second year, and once a year thereafter. The mean follow-up time was 57.5 months. Before the treatment, average hydatid cyst volume was 2,145 ml that was reduced to 145 ml post-treatment at the time of delivery. The first five cases of the study had solid appearance of the cyst remnant (indicating complete cure) in 22 months. Cystobiliary fistula was suspected in the sixth case three months after delivery. After confirmation of the cystobiliary fistula with cystography, a percutaneous catheter was placed into the postresidual cavity and a nasobiliary catheter was placed into the common bile duct after syphincterotomy. The fistula was closed in 2 weeks. This patient has a follow-up time of 1 year so far without any problem. No mortality, morbidity, fetal loss, abdominal dissemination, or tract seeding was observed among our cases. Percutanous treatment of hydatid cysts in pregnancy is an efficient and safe procedure in cases where percutaneous treatment is indicated.

Modified PAIR Technique for Percutaneous Treatment of High-Risk Hydatid Cysts

This paper presents a modification of the known method for percutaneous treatment of hydatid cyst, the PAIR technique. It aimed to achieve safe aspiration of large symptomatic cysts and cysts with a danger of impending rupture. We designed a coaxial catheter system to achieve concomitant evacuation of cyst contents while infusing scolicidal agent. Hypertonic saline is used to wash out cyst contents and to kill protoscolices. This was followed by injection of a sclerosant (ethyl alcohol 95%) into the residual cyst cavity to prevent formation of a cyst collection after the procedure. Seventeen cysts in 14 patients were successfully aspirated. Follow-up plain radiographs, ultrasonography and CT were performed weekly in the first 4 weeks and then at 3, 6 and 12 months for all patients. Seven patients (9 drained cysts) were followed up for 2 years and 1 patient for 3 years. All cysts were successfully aspirated. The following morphologic changes were noticed: a gradual decrease in cyst size (17 cysts, 100%), thickening and irregularity of the cyst wall due to separation of endocyst from pericyst (7 cysts, 41%), development of a heterogeneous appearance of the cyst components (8 cysts, 47%) and development of pseudotumor (2 cysts, 12%). None of the treated cysts disappeared completely. No significant procedure-related complications were encountered. This modified PAIR technique is a reliable method for percutaneous treatment of risky and symptomatic hydatid cysts.

A new therapeutic approach for treatment of hydatid cysts of the spleen.

The aims of this study were to investigate the efficacy of a new percutaneous treatment of hydatid cysts of the spleen and to present the results of long-term follow-up. Nine patients (six men, three women; median age 37 years) with 10 hydatid cysts in the spleen underwent a new percutaneous treatment. The procedure included the puncture and free drainage of the cyst fluid under sonographic guidance. After drainage has stopped, alcohol 96% and polidocanol 1% were used as sclerosing agents. The patients were followed up with periodic sonographic examinations. The median follow-up period was 39 months (range: 6-64 months). The median diameter of the cysts decreased from 63.0 mm to 33.3 mm (P < 0.01). The entire cyst cavity filled with a solid echo pattern in three cysts, two thirds of the cyst cavity showed a pseudotumor pattern in three cysts, and one third of the cyst cavity showed a pseudotumor pattern in four cysts. Apart from an urticarial reaction, no major complications occurred during the follow-up period. One patient had under-gone splenectomy due to persistent left upper quadrant pain eight months after treatment. Long-term results indicate that this new treatment modality of splenic hydatidosis is an effective and safe method and causes no major complications.

A new percutaneous approach for the treatment of hydatid cysts of the liver

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0 ± 2.7 mm to 63.0 ± 2.5 mm ( p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.

PAIR as percutaneous treatment of hydatid liver cysts

Hydatid disease of the liver remains an important and challenging problem in rural areas; although, surgery is considered the treatment of choice, percutaneous treatment of hydatid cysts is relatively new, and the data related to it are limited. The purpose of the study was to present the results of percutaneous treatment of liver hydatid cysts. Thirty-four patients (13 male and 21 female), ranging in age between 14 and 80 years, with 55 liver hydatid cysts underwent percutaneous treatment with albendazole prophylaxis. Cysts were treated with a one-stage procedure that consisted of puncture of the cysts under guidance with computed tomography, aspiration of fluid, injection of hypertonic saline solution as scolicidal agent and reaspiration. Follow-up examinations showed progressive reduction and solidification of the cysts. The mean reduction in volume was 72%. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications were urticaria with pruritus in two patients. One patient had a subcapusular hematoma without problem. Hospitalization courses varied from ambulatory procedures to 15 days of in-patient, mean hospital stay was 1.82 days. The results of percutaneous liver hydatid cyst treatment, indicating that the procedure is efficient and safe and offers complete cure in selected patients with a short hospitalization and that this technique should be considered an alternative to surgery.

Percutaneous treatment of hepatic hydatid cysts: an alternative to surgery.

Percutaneous treatment of hydatid cysts is relatively new, and the data related to it are limited. The purpose of this study was to provide additional data to strengthen the proof of its effectiveness. One hundred sixty-eight hepatic cysts in 111 patients were treated using a percutaneous approach under sonographic and fluoroscopic guidance. Cysts smaller than 5 cm in diameter were treated with a one-stage procedure that consisted of puncture of the cyst, aspiration of fluid, and injection and reaspiration of hypertonic saline solution. Larger cysts were treated with a two-stage procedure that consisted of the one-stage procedure followed by catheterization and sclerotherapy with alcohol. The mean observation time was 19 months (range, 1-48 months). Follow-up examinations showed progressive shrinkage and solidification of the cysts. Early complications occurred in 32 (28.8%) of the 111 patients, including fatal anaphylaxis in one patient, biliary fistula in seven, infection of the cyst in four, persistent serous drainage from the cyst in two, intraperitoneal leakage of cyst fluid in two, urticaria in seven, fever without evidence of infection in seven, and pleural effusion in two. Late complications occurred in four (3.8%) of the 104 patients who underwent follow-up examinations, including local recurrence in three patients and intrabiliary rupture of a cyst in one patient. Our experience indicates that percutaneous treatment is efficient in the management of hepatic hydatid cysts and that this technique should be considered an alternative to surgery.

Percutaneous treatment of hydatid cysts of the liver: long-term results.

The purpose of the study was to present the long-term results of percutaneous treatment of liver hydatid cysts. Seventy-two patients (44 male and 28 female, ranging in age between 10 and 69 years; mean age, 35 years) with 106 liver hydatid cysts underwent percutaneous treatment with albendazole prophylaxis. Puncture, aspiration, injection, and reaspiration (PAIR) were used for hydatid cysts smaller than 6 cm (n = 66). Larger cysts (n = 40) were treated by catheterization. Hypertonic saline solution and absolute alcohol were used as the cytotoxic and sclerosing agents. Sonographic guidance with or without fluoroscopy was used in all patients. Follow-up was mainly by sonography every third month of the first year, every sixth month of the second year, and once a year thereafter. The mean follow-up time was 37 months. The mean reduction in volume at the time of the first follow-up was 87.0% and 73.5% in catheterization and PAIR patients, respectively. The immediate sonographic changes after treatment were detachment of the endocyst and disappearance of the regular endocyst, with a reduction in the fluid component. The solid appearance of the cyst remnant indicated complete cure as the cyst wall became irregular and thicker. The average time for development of a solid appearance was 19 months in PAIR patients and 26 months in catheterization patients. Seventy of 72 patients were cured, whereas two recurrences (2.8%) were observed. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications were urticaria and fever in eight patients (11.1%). Major complications were infection of the cyst cavity in two patients (2.8%) and development of biliary fistula in four patients (5.6%). Mean hospitalization times were 17 days for complicated cases and I day for uncomplicated cases. The long-term results of percutaneous liver hydatid cyst treatment accord with short-term results, indicating that the procedure is efficient and safe and offers complete cure in selected patients with a short hospitalization.

Percutaneous treatment of hydatid cysts under sonographic guidance

Nine patients (five males, four females) with 14 hydatid cysts were treated with albendazole and percutaneous drainage under sonographic guidance. All but two cysts were hepatic. The average cyst diameter was 81.5 mm (range: 42-180 mm). There were eight type 1 cysts, two type 2, three type 3, and a single type 4. Type 1 and 2 cysts were treated by needle aspiration, type 3 and 4 by needle decompression and catheter drainage. The residual cavity was irrigated with 30% hypertonic saline and injected with absolute alcohol. Biliary fistulization contraindicated alcohol use. All cysts were successfully treated. A single episode of reversible anaphylaxis was encountered. Serial sonographic examinations revealed residual cavities ranging from 10 to 35 mm in diameter. No new cysts were noted during an average follow-up of 9.6 months. The mean hospital stay was 48 hr. Percutaneous drainage of hydatid cysts is a relatively safe and cost-effective procedure.

Percutaneous treatment of hydatid cysts (Echinococcus Granulosus)

A new method called PAIR (Puncture-Aspiration of cyst contents--Injection of hypertonic saline solution--Reaspiration) was used as a percutaneous treatment of hydatid cysts. In 37 patients, 120 cysts were punctured. All patients had not been considered surgical candidates. The cysts were localized in the liver, peritoneum, spleen, kidneys, muscles, and bones. In 70% of patients, good results were obtained. Recurrence occurred in 5 of 120 cysts, all at the beginning of our experience when a low concentration of sodium chloride solution was injected. Moderate allergic reactions occurred during seven cyst aspirations. No anaphylactic shock, sudden deaths or dissemination of cyst contents were observed.