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Govindaraj S, Bhadra V, Prakash C, Govindaraj S. Unusual case of disappearing hepatic hydatid cyst: COVID-19 times. BMJ Case Rep 2021; 14:14/8/e243533. [PMID: 34353833 PMCID: PMC8344285 DOI: 10.1136/bcr-2021-243533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The larvae of the tapeworm Echinococcus granulosus cause echinococcosis or hydatid disease. Liver is the most commonly involved organ accounting for 60%–80%. Rupture into the biliary radicle through a cystobiliary communication is the most anticipated complication seen in 5%–17%, presenting with obstructive jaundice and cholangitis. We present a young patient who had presented with cholangitis and a tender hepatomegaly. Contrast-enhanced CT (CECT) had revealed a large hepatic hydatid cyst with multiple daughter cysts and significant dilatation of intrahepatic/extrahepatic biliary system. He had undergone an emergency Endoscopic Retrograde Cholangiopancreatography (ERCP) with extraction of the membranes and stenting of the common bile duct. A few cycles of albendazole were given to sterilise before elective laparoscopic surgery. However, a follow-up CECT showed complete resolution of the hepatic hydatid with calcification. In conclusion, medical treatment with a few cycles of albendazole and ERCP with stenting could be a good treatment option.
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Affiliation(s)
- Shrenik Govindaraj
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Veera Bhadra
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Clement Prakash
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Sridar Govindaraj
- Department of General and Laparoscopic Surgery, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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Handoo N, Fazili MUR, Gayas MA, Athar H, Tariq R. Percutaneous aspiration-injection-reaspiration (PAIR) for the treatment of abdominal cysts: Initial report in sheep and goat. Acta Vet Hung 2021; 68:393-398. [PMID: 33459611 DOI: 10.1556/004.2020.00059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
Percutaneous aspiration-injection-reaspiration (PAIR), also called sclerotherapy, is a minimally invasive, inexpensive and safe technique for the treatment of abdominal cysts in humans. A study was planned to evaluate the feasibility of this procedure in the management of abdominal cysts in sheep and goat. Adult ewes (n = 5) and one doe (n = 1) found to have abdominal cysts (one cyst/animal) on repeated survey ultrasonography (USG) were included in the study. The animals were restrained in standing position. A hypodermic needle (G-18) securely attached to a 10-mL Dispovan syringe was carefully passed under ultrasound guidance into the abdominal cyst in all these animals. Depending on the size of the cyst, 1.0-5.5 mL fluid was aspirated, and 0.5-2.0 mL of 20% hypertonic saline solution infused. The needle was thereafter kept in situ for 10 min. The maximum possible volume of the cyst content was reaspirated and the needle withdrawn. On day 7, sclerotherapy was repeated in five animals showing no appreciable reduction in cyst size by USG. USG was repeated on days 30 and 90. All the cysts except one responded to PAIR during this period. From this study it can be concluded that sclerotherapy using hypertonic saline (20%) is a minimally invasive, inexpensive, effective and safe interventional ultrasonographic technique for the treatment of abdominal cysts in sheep and goats. However, the procedure needs further evaluation after using different sclerotic agents of varying concentrations and duration of their retention in the cysts in a sufficient number of animals with cysts.
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Affiliation(s)
- Nida Handoo
- 1Division of Veterinary Surgery and Radiology, Faculty of Veterinary Sciences and Animal Husbandry, SKUAST, Kashmir, Srinagar, Jammu and Kashmir, India
| | - Mujeeb Ur Rehman Fazili
- 2Division of Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, SKUAST, Kashmir, H. No. 78, HIG Colony, Bemina, Srinagar, 190018 India
| | - Mohammad Abrar Gayas
- 1Division of Veterinary Surgery and Radiology, Faculty of Veterinary Sciences and Animal Husbandry, SKUAST, Kashmir, Srinagar, Jammu and Kashmir, India
| | - Hakim Athar
- 1Division of Veterinary Surgery and Radiology, Faculty of Veterinary Sciences and Animal Husbandry, SKUAST, Kashmir, Srinagar, Jammu and Kashmir, India
| | - Raja Tariq
- 3Division of Animal Genetics and Breeding, Faculty of Veterinary Sciences and Animal Husbandry, SKUAST, Kashmir, Srinagar, Jammu and Kashmir, India
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3
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Sokouti M, Sadeghi R, Pashazadeh S, Abadi SEH, Sokouti M, Ghojazadeh M, Sokouti B. A systematic review and meta-analysis on the treatment of liver hydatid cyst using meta-MUMS tool: comparing PAIR and laparoscopic procedures. Arch Med Sci 2019; 15:284-308. [PMID: 30899281 PMCID: PMC6425195 DOI: 10.5114/aoms.2018.73344] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION There is an academic debate over surgical treatments of liver hydatid cyst disease. In this study, a systematic review and meta-analysis were carried out in order to evaluate the pros and cons of both PAIR (Puncture, Aspiration, Injection, Respiration) and laparoscopic techniques by considering the outcomes of liver hydatid cysts. MATERIAL AND METHODS We designed descriptive Boolean queries to search two databases, PubMed and Scopus, to derive the articles published in the period of January 2000 to December 2016 in order to evaluate the outcomes of these research articles. The outcomes of laparoscopic and PAIR procedures include the rates of cure, postoperative complications, recurrences, and mortality, which were extracted, assessed, and used as their corresponding effect sizes. RESULTS Fifty-seven studies including a total of 2832 patients (PAIR group n = 1650 and laparoscopic group = 1182) were analyzed. In this meta-analysis study, a random effect model of correlations of outcomes (postoperative complications, mortalities, recurrences, and cure rates) of PAIR and laparoscopy procedures was used. The meta-analysis and the forest plots of the two procedures show that the PAIR approach is superior in terms of cure, complication, and mortality rates compared with the laparoscopy technique. However, the recurrence rate is low in laparoscopic approaches. Moreover, Egger's tests for determining publication bias and heterogeneity tests were also performed. CONCLUSIONS This study shows promising trends toward an advantage of PAIR procedures in treatment of liver hydatid cyst in comparison with laparoscopic procedures. The PAIR procedure is superior to laparoscopy due to having a higher cure rate and lower complication and mortality rates; however, the latter has a lower recurrence rate.
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Affiliation(s)
- Massoud Sokouti
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeid Pashazadeh
- Department of Computer and Electrical Engineering, University of Tabriz, Tabriz, Iran
| | - Saeed Eslami Hasan Abadi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Sokouti
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Botsa E, Thanou I, Nikas I, Thanos L. Treatment of Hepatic Hydatid Cyst in a 7-Year-Old Boy Using a New Type of Radiofrequency Ablation Electrode. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:953-958. [PMID: 28871077 PMCID: PMC5595407 DOI: 10.12659/ajcr.904432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patient: Male, 7 Final Diagnosis: Echinococcosis Symptoms: Cough • fever Medication: — Clinical Procedure: Medical treatment and RFA of liver cyst Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Evanthia Botsa
- First Pediatric Clinic, National and Kapodistrian University of Athens, Agia Sofia Children's Hospital, Thivon and Levadias, Goudi, Athens, Greece
| | - Ioanna Thanou
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
| | - Ioannis Nikas
- Department of Medical Imaging and Interventional Radiology, Agia Sofia Children's Hospital, Thivon and Levadias, Goudi, Athens, Greece
| | - Loukas Thanos
- Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens, Greece
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Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8:1169-1181. [PMID: 27729953 PMCID: PMC5055586 DOI: 10.4254/wjh.v8.i28.1169] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence.
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Erkoç MF, Öztoprak B, Alkan S, Okur A. A rare cause of pleural effusion: ruptured primary pleural hydatid cyst. BMJ Case Rep 2014; 2014:bcr-2013-202959. [PMID: 24604800 DOI: 10.1136/bcr-2013-202959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hydatidosis is an endemic parasitic disease in Mediterranean countries, often caused by the dog tapeworm Echinococcus granulosus. The disease predominantly affects the liver (60-70%) and lungs (30%), and the surgical management is considered as the gold standard for treatment. Besides anaphylactic reactions, the most frequent complication of the hydatid disease is rupture into neighbouring structures, often affecting the bronchi, gastrointestinal tract and peritoneal/pleural cavities, according to its location. Primary pleural hydatidosis is an extremely rare entity and we present a ruptured pleural hydatid cyst with unusual location.
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Chute DJ, Sarti M, Atkins KA. Liver cytology. Cancer Treat Res 2013; 160:83-109. [PMID: 24092368 DOI: 10.1007/978-3-642-38850-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Deborah J Chute
- Cleveland Clinic Department of Anatomic Pathology, 9500 Euclid Avenue L25, Cleveland, OH, 44195, USA
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Rajesh R, Dalip DS, Anupam J, Jaisiram A. Effectiveness of puncture-aspiration-injection-reaspiration in the treatment of hepatic hydatid cysts. IRANIAN JOURNAL OF RADIOLOGY 2013; 10:68-73. [PMID: 24046781 PMCID: PMC3767020 DOI: 10.5812/iranjradiol.7370] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/12/2012] [Accepted: 11/29/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hydatid disease of the liver is endemic in cattle rearing areas of the world. A variety of treatment options are available in its management. The common treatment options are medical therapy, surgery and puncture-aspiration-injection-reaspiration (PAIR) therapy. OBJECTIVES This study was performed to evaluate the effectiveness of PAIR therapy in the treatment of hepatic hydatid disease. PATIENTS AND METHODS This cross sectional study was carried out on 15 consecutive patients (Male: 2, Female: 13; Age group: 11-80 years) with hepatic hydatid disease and were treated by PAIR therapy and followed up for a period of 1 year. The cysts were punctured under local anesthesia with an 18G needle using sonographic guidance. Betadine (10% povidone iodine + 1% free iodine) was used as scolicidal agent and allowed to act for 30 min. Cysts larger than 5 cm (n = 5) were drained using an 8F pig tail catheter. The therapeutic response was studied by assessing the reduction in the cyst size, progressive solidification of the cyst, calcification of the wall and increase in the echogenicity of the cyst with pseudomass appearance on serial ultrasound examinations performed on the next day, after 1 month, at 3 months, 6 months and 1 year after the procedure. RESULTS Ten patients (66.7%) had Gharbi type I cysts, two (13.3%) had type II and three (20%) had type III cysts. All the patients (100%) showed reduction in cyst size over a 3-6 month period. Pseudomass appearance with solidification was seen in 73% of the patients and calcification was seen in 46.6%. None of the patients developed anaphylaxis, recurrence or peritoneal seedlings. Pain at the injection site was the most common complication observed. CONCLUSION PAIR therapy is an effective minimally invasive treatment for Gharbi type I-III hepatic hydatid cysts. It is a cost effective and safe procedure with significant reduction in the duration of hospital stay.
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Affiliation(s)
- Raman Rajesh
- Department of Radiodiagnosis, JSS Medical College, Mysore, India
- Corresponding author: Raman Rajesh, Department of Radiodiagnosis, JSS Medical College, Mysore, India. Tel.: +91-9481822984, Fax: +91-2548218, E-mail:
| | - Dhiman S. Dalip
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | - Jhobta Anupam
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
| | - Azad Jaisiram
- Department of Radiodiagnosis, Indira Gandhi Medical College, Shimla, India
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Giant Liver Hydatid Cyst. ARS MEDICA TOMITANA 2013. [DOI: 10.2478/v10307-012-0010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Hydatiosis due to Echinococcus granulosus is an endemic parasitic zoonosis characterized by worldwide distribution. The most commonly involved anatomical locations are the liver and lung. The autors present a 12-year-old patient with a giant hepatic echinococcus cyst misdiagnosed as an abdominal malignancy during formal investigation. The patient was admitted to the hospital complaining for abdominal pain and with an important abdominal distention. Abdominal computed tomography revealed a giant abdominal mass: 23/21 cm, resembling a tumor, adherent to the liver edges and parietal peritoneum. The patient was taken into operation, and an a giant liver hydatid cyst was removed despite the radiological findings and the preoperative clinical suspicion.
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Lev-Tzion R, Goldbart AD. Endobronchial echinococcosis presenting as non-resolving pneumonia. Pediatr Pulmonol 2012; 47:716-8. [PMID: 22162447 PMCID: PMC3307883 DOI: 10.1002/ppul.21597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/10/2011] [Indexed: 11/09/2022]
Abstract
Hydatid disease of the lungs is caused by larval cysts of the Echinococcus tapeworm. Pulmonary cysts may occasionally invade bronchi or pleura as a result of coughing, trauma, or elevated intra-abdominal pressure. We present the case of a patient evaluated for non-resolving pneumonia whose radiographic and bronchoscopic findings were strikingly similar to those seen in pulmonary tuberculosis with endobronchial invasion; he was ultimately diagnosed with pulmonary echinococcosis. This case underscores the importance of considering unusual diagnoses even when typical features of more common conditions are present.
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Affiliation(s)
- Raffi Lev-Tzion
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri 63110-1093, USA.
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Abstract
Benign pathologies of the liver often include several cystic diseases, such as simple cysts, autosomal dominant polycystic liver disease, and Caroli's disease. The differential of hepatic cysts also includes infectious pathologies, such as pyogenic liver abscess, hydatid cysts, and parasitic infections if the appropriate clinic setting. Understanding of the various causes, clinical presentation, and treatment options is required to ensure the appropriate surgical management of these patients.
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Affiliation(s)
- Kaye M Reid-Lombardo
- Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street South West, Rochester, MN 55905, USA.
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Abstract
Liver hydatidosis is the most common clinical presentation of cystic echinococcosis (CE). Ultrasonographic mass surveys have demonstrated the true prevalence, including the asymptomatic characteristic of the majority of cases, providing new insight into the natural history of the disease. This raises the question of whether to treat or not to treat these patients, due to the high and unsuspected prevalence of CE. The high rate of liver/lung frequencies of cyst localization, the autopsy findings, and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion. The decision to treat an asymptomatic patient by surgery, albendazole, or puncture aspiration injection and reaspiration or to wait and watch, is based on conflicting reports in the literature, the lack of complications in untreated patients over time, and the spontaneous disappearance and involution of cysts. All these points contribute to difficulties of individual clinical decisions. The patients should be informed of the reasons and the risks of watchful/waiting without treatment, the possibility of complications, and the risks of the other options. As more information on the natural history of liver hydatidosis is acquired, selection of the best treatment will be come easier. Without this knowledge it would be very difficult to establish definitive rules of treatment. At present, it is possible to manage these patients over time and to wait for the best moment for treatment. Follow-up studies must be conducted to achieve this objective.
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Marriott PJ, Karani J, Lucas SB, Chiodini PL, Heaton ND. Anaphylaxis from intravascular rupture of Hydatid disease following liver trauma. J Surg Case Rep 2010; 2010:1. [PMID: 24946335 PMCID: PMC3649144 DOI: 10.1093/jscr/2010.7.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cystic Echinococcosis also known as cystic hydatid disease is a parasitic infection endemic in many parts of the world. Humans are accidental intermediate hosts with cysts most commonly developing in the liver. This case describes a rare presentation of hydatid disease following trauma to the liver. Intraparenchymal cyst rupture led to haemodynamic instability with release of the parasites protoscolices into hepatic venules producing severe life threatening anaphylaxis.
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14
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Neuville M, Grisoli D, Nicoud A, Jacquier A, Lagier JC, Collart F, Thomas P, Parola P. Cardiac hydatidosis. Am J Trop Med Hyg 2010; 83:102-3. [PMID: 20595485 DOI: 10.4269/ajtmh.2010.10-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report a case of an adult who developed superior vena cava syndrome because of cardiac hydatidosis. A 37-year-old man from Morocco developed progressive dyspnoea and cough. Cardiac hydatidosis was diagnosed because of both the typical radiological findings and the positive serology for echinococcosis. The patient was treated by surgery and albendazole without complications.
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Affiliation(s)
- Mathilde Neuville
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Marseille, France
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Carter C, Bonatti H, Hranjec T, Barroso LF, Donowitz G, Sawyer RG, Schirmer B. Epigastric cystic echinococcus involving stomach, liver, diaphragm, and spleen in an immigrant from Afghanistan. Surg Infect (Larchmt) 2010; 10:453-6. [PMID: 19673596 DOI: 10.1089/sur.2008.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although cystic echinococcus (CE) is a common disorder worldwide, few cases are treated in the United States and other industrialized countries. Migration and tourism have caused an increase in the incidence of this parasitic infection in industrialized countries, and physicians must be familiar with its management. METHODS We report successful therapy of CE in an immigrant from Afghanistan. RESULTS The patient presented with a large epigastric mass that was initially misdiagnosed as gastric gastrointestinal stromal tumor. The mass was removed, together with partial gastrectomy, splenectomy, and resection of the left lateral segments of the liver, and diagnosis of CE was made. The patient recovered from surgery, albendazole was started, and at five months follow up, he is recurrence free. CONCLUSIONS Echinococcus granulosus must be considered in immigrants and travelers presenting with a cystic mass.
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Affiliation(s)
- Cullen Carter
- Department of Surgery, University of Virginia Health Services, Charlottesville, Virginia 22908-0709, USA
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Pseudotumoral hydatid cyst: report of a case. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2009; 2009:137956. [PMID: 19707533 PMCID: PMC2730560 DOI: 10.1155/2009/137956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/12/2009] [Accepted: 06/30/2009] [Indexed: 12/28/2022]
Abstract
Hydatidosis due to Echinococcus granulosus is an endemic parasitic zoonosis characterized by worldwide distribution particularly in Mediterranean countries. The most commonly involved anatomical locations are the liver and lung. Occasionally the cyst may progressively increase in size, mimicking gross ascites or intrabdominal tumor. Herein, are reported a case of a 40-year-old patient with a giant exophytically expanded hepatic echinococcus cyst, misdiagnosed as an abdominal malignancy during formal investigation. The patient was admitted to the hospital complaining for mild diffuse abdominal tenderness, moderate abdominal pain, nausea, diarrhoea, and vomiting. A CT scan revealed the presence of a giant abdominal mass 25 × 21 × 14 cm, resembling a tumor, adherent to the liver edges and parietal peritoneum, displacing intestinal loops. During the ensuing days the patient's clinical condition worsened, and he became febrile. Exploratory laparotomy was performed, and an exophytically grown giant liver hydatid cyst was removed, despite the radiological findings and the preoperative clinical suspicion.
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Lamonaca V, Virga A, Minervini MI, Di Stefano R, Provenzani A, Tagliareni P, Fleres G, Luca A, Vizzini G, Palazzo U, Gridelli B. Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation: An ex-vivo pilot experimental study in animal models. World J Gastroenterol 2009; 15:3232-9. [PMID: 19598298 PMCID: PMC2710778 DOI: 10.3748/wjg.15.3232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate radiofrequency thermal ablation (RTA) for treatment of cystic echinococcosis in animal models (explanted organs).
METHODS: Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80°C, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic.
RESULTS: The subjects of the study were 17 cysts (nine hepatic and eight pulmonary), who were treated with RTA. Pathology showed 100% success rate in both hepatic (9/9) and lung cysts (8/8); immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts.
CONCLUSION: RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in vivo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.
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Fisichella PM, Donaldson K, Helton WS. Hepatic and splenic hydatidosis managed with percutaneous aspiration, injection, and reaspiration (PAIR) of the hepatic cyst and laparoscopic splenectomy. J Gastrointest Surg 2008; 12:1615-7. [PMID: 18040746 DOI: 10.1007/s11605-007-0419-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Accepted: 11/02/2007] [Indexed: 01/31/2023]
Abstract
The treatment of hydatidosis traditionally consisted of surgery with a perioperative course of anthelmintic medications. However, percutaneous aspiration, injection, and reaspiration (PAIR) combined with oral albendazole has been recently shown to be as effective as surgery in the treatment of liver hydatidosis. We report a 20-year-old female immigrant from Western Europe who presented with discomfort in her upper abdomen. Computed tomography revealed a 5.7 x 7 x 5.9-cm cyst in segment 7 of the liver and a 17 x 15-cm cyst in the spleen in contiguity with the hilar vessels. Indirect hemaglutination test confirmed hydatidosis. A strategy with two different surgical approaches was designed to treat her condition: laparoscopic splenectomy and ultrasound-guided PAIR of the liver cyst. The patient was discharged on postoperative day 5, and at 18 months follow-up, she is free of symptoms.
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Affiliation(s)
- P Marco Fisichella
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
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20
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Losanoff JE, Gruber SA, Basson MD. Percutaneous treatment of giant abdominal hydatid cysts. Surg Endosc 2007; 21:688-9. [PMID: 17285376 DOI: 10.1007/s00464-006-9145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 09/22/2006] [Indexed: 11/29/2022]
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