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Li P, Wang Y, Yang Q, Ni M, Fan J, Huang Z. Management of breech presentation with a large pelvic hydatid cyst in late pregnancy in Tibet: a case report. BMC Pregnancy Childbirth 2022; 22:858. [PMID: 36404300 PMCID: PMC9675952 DOI: 10.1186/s12884-022-05180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hydatid cystic disease (HCD) is primarily a disease of sheep and cattle. Human beings are accidental hosts. It is prevalent in the Tibet Autonomous Region (TAR) of China. In pregnancy, it can cause many complications. CASE PRESENTATION We present a multigravida with breech presentation at 37 weeks of pregnancy in whom a large pelvic hydatid cyst and multiple hepatic hydatids were diagnosed by ultrasonography. The large pelvic hydatid cyst was drained through the posterior fornix under the guidance of ultrasound, and an external cephalic version was performed. A healthy baby was delivered vaginally with head presentation at term. CONCLUSION HCD during pregnancy presents with management difficulty. It is important to formulate individualized treatment plans according to the actual situation of the patient and the local level of treatment.
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Affiliation(s)
- Ping Li
- grid.412558.f0000 0004 1762 1794Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Wang
- grid.412558.f0000 0004 1762 1794Laboratory of Biochemistry, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qi Yang
- grid.412558.f0000 0004 1762 1794Department of Pharmacy, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ma Ni
- grid.513202.7Department of Obstetrics and Gynecology, Chaya County People’s Hospital, Tibet, China
| | - Jianhui Fan
- grid.412558.f0000 0004 1762 1794Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zeping Huang
- grid.412558.f0000 0004 1762 1794Department of Ultrasonography, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600, Tianhe road, 510630 Guangzhou, China
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Lissandrin R, Vola A, Mariconti M, Filice C, Manciulli T, Tamarozzi F, Brunetti E. Conservative Management of Liver Echinococcal Cysts in Pregnant Women: One Center's Experience in Pavia, Italy. Am J Trop Med Hyg 2022; 106:tpmd210612. [PMID: 35405650 PMCID: PMC9209927 DOI: 10.4269/ajtmh.21-0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022] Open
Abstract
Human cystic echinococcosis (CE) in pregnancy is rarely reported, with approximately one case of CE for every 20,000 to 30,000 pregnant women in endemic areas. Little information on its management is available. We report our experience with a watch-and-wait approach in this group of patients. We retrieved clinical data from pregnant patients with hepatic CE seen at our clinic from 1989 to 2021. All patients had at least one hepatic CE cyst and received no treatment during pregnancy. Ultrasound was used to monitor cyst evolution; outcome and complications of pregnancy and echinococcal infection were evaluated. Twelve patients with 15 pregnancies were included in this study. At the time of pregnancy, nine patients had a single cyst and two patients had multiple hepatic CE cysts. Cysts were in stage CE3a, CE3b, CE4, and CE5, according to the WHO Informal Working Group on Echinococcosis classification. All cysts except one remained stable in stage and size during and after pregnancy. In one patient with a history of multiple treatments with albendazole and with a CE4 cyst at the start of pregnancy, reactivation of the cyst during pregnancy was observed. All pregnancies except three had eutocic delivery. Cesarean sections were performed for reasons unrelated to CE. In our experience, "watch and wait" in pregnant women with uncomplicated transitional and inactive CE of the liver was a safe option in a small cohort of patients. Pooled data from other referral centers, including cases with CE1 and CE2 cysts, are needed to confirm the safety of this approach.
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Affiliation(s)
- Raffaella Lissandrin
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Ambra Vola
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Mara Mariconti
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Carlo Filice
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Tommaso Manciulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Francesca Tamarozzi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Infectious and Tropical Diseases, IRCCS San Matteo Hospital Foundation, Pavia, Italy
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3
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Noori IF. Liver hydatid diseases of the pregnancy: Management approaches and outcomes. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Interventional radiological management of hepatobiliary disorders in pregnancy. Clin Exp Hepatol 2020; 6:176-184. [PMID: 33145424 PMCID: PMC7592089 DOI: 10.5114/ceh.2020.99508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
Hepatobiliary disorders are common in pregnancy and pose a management challenge. Minimally invasive interventional radiological (IR) techniques allow safe and effective management of these disorders. However, the available literature is scarce. Radiological interventions in this group of patients mandate a clear understanding of the risks of radiation to the fetus. The IR physician involved in the care of these patients should be aware of the measures to minimize the exposure to ionizing radiation. Additionally, the risk-benefit ratio should be clearly defined in a multidisciplinary discussion involving IR physicians, obstetricians, and gastroenterologists. This review is an effort to address issues related to the application of IR procedures for hepatobiliary disorders in pregnant patients.
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Repair of diaphragmatic biliary pleural fistula in a hydatid cyst with pericardial patch: A case report. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.660987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Percutaneous Treatment of Giant Cystic Echinococcosis in Liver: Catheterization Technique in Patients with CE1 and CE3a. Cardiovasc Intervent Radiol 2019; 42:1153-1159. [DOI: 10.1007/s00270-019-02248-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/17/2019] [Indexed: 01/17/2023]
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Musaev GK, Sharipov RK, Fatyanova AS, Levkin VV, Ishchenko AI, Zuyev VM. [Echinococcosis and pregnancy: approaches to the treatment]. Khirurgiia (Mosk) 2019:38-41. [PMID: 31169817 DOI: 10.17116/hirurgia201905138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM To develop treatment strategy in pregnant women with liver echinococcosis. MATERIAL AND METHODS There were 21 women with confirmed diagnosis of liver echinococcosis who were divided into 2 groups. Group I consisted of 17 patients with cysts Charbi grade I-III. They underwent percutaneous puncture and antiparasitic management of the cyst under intravenous sedation. Group II included 4 patients with cysts grade IV-V and those with multiple cysts. They underwent conventional surgery. RESULTS In one patient, fetal death occurred in 20 hours after surgery and it was not associated with the procedure. There were no complications in other patients. Uneventful childbirth was noted in all of them. CONCLUSION Percutaneous puncture in the second trimester of pregnancy is effective and safe procedure for prevention of complications of echinococcosis in late pregnancy and childbirth. Conventional surgery is alternative if percutaneous intervention is not advisable.
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Affiliation(s)
- G Kh Musaev
- Republican Clinical hospital of the Makhachkala, Dagestan Republic, Russia
| | - R Kh Sharipov
- Chair of Faculty-Based Surgery #1 of Medical Faculty of the Sechenov First Moscow State Medical University, Moscow, Russia
| | - A S Fatyanova
- Chair of Oncology and Reconstructive Surgery of Medical Faculty of the Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Levkin
- Chair of Faculty-Based Surgery #1 of Medical Faculty of the Sechenov First Moscow State Medical University, Moscow, Russia
| | - A I Ishchenko
- Chair of Obstetrics and Gynecology of Medical Faculty of the Sechenov First Moscow State Medical University, Moscow, Russia
| | - V M Zuyev
- Chair of Obstetrics and Gynecology of Medical Faculty of the Sechenov First Moscow State Medical University, Moscow, Russia
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Tamarozzi F, Vuitton L, Brunetti E, Vuitton DA, Koch S. Non-surgical and non-chemical attempts to treat echinococcosis: do they work? ACTA ACUST UNITED AC 2014; 21:75. [PMID: 25531730 PMCID: PMC4273701 DOI: 10.1051/parasite/2014071] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/11/2014] [Indexed: 12/14/2022]
Abstract
Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA), were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration) and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP)-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.
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Affiliation(s)
- Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Via Brambilla 74, 27100 Pavia, Italy - WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Via Taramelli 5, 27100 Pavia, Italy
| | - Lucine Vuitton
- Gastroenterology and Endoscopy Unit, Besançon University Hospital, Bd Fleming, 25000 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| | - Enrico Brunetti
- Department of Clinical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Via Brambilla 74, 27100 Pavia, Italy - WHO-Collaborating Centre for Clinical Management of Cystic Echinococcosis, Via Taramelli 5, 27100 Pavia, Italy - Division of Tropical Infectious Diseases, San Matteo Hospital Foundation, Via Taramelli 5, 27100 Pavia, Italy
| | - Dominique Angèle Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
| | - Stéphane Koch
- Gastroenterology and Endoscopy Unit, Besançon University Hospital, Bd Fleming, 25000 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25000 Besançon, France
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Hydatid Cyst of Liver Presented as Obstructive Jaundice in Pregnancy; Managed by PAIR. J Clin Exp Hepatol 2014; 4:366-9. [PMID: 25755583 PMCID: PMC4298637 DOI: 10.1016/j.jceh.2014.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/21/2014] [Indexed: 12/12/2022] Open
Abstract
Incidence of Hydatid disease in pregnancy ranges from 1in 20,000 to 1 in 30,000. The most common site of hydatid cysts is the liver. The diagnosis of liver hydatid cysts is not difficult but the management during pregnancy is problematic. Both medical and surgical treatments are available but there is no consensus and each case has to be individualized. We present a case of liver hydatid cyst presented with obstructive jaundice during pregnancy which was managed by Puncture of the cyst under USG guidance; Aspiration of the cystic fluid, Injection of hypertonic saline, and Re-aspiration of solution without drainage (PAIR) and albendazole therapy. Very few cases of liver hydatosis were reported previously which had been managed by PAIR.
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Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114:1-16. [PMID: 19931502 DOI: 10.1016/j.actatropica.2009.11.001] [Citation(s) in RCA: 1173] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 11/02/2009] [Accepted: 11/04/2009] [Indexed: 12/13/2022]
Abstract
The earlier recommendations of the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) for the treatment of human echinococcosis have had considerable impact in different settings worldwide, but the last major revision was published more than 10 years ago. Advances in classification and treatment of echinococcosis prompted experts from different continents to review the current literature, discuss recent achievements and provide a consensus on diagnosis, treatment and follow-up. Among the recognized species, two are of medical importance -Echinococcus granulosus and Echinococcus multilocularis - causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. For CE, consensus has been obtained on an image-based, stage-specific approach, which is helpful for choosing one of the following options: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait. Clinical decision-making depends also on setting-specific aspects. The usage of an imaging-based classification system is highly recommended. For AE, early diagnosis and radical (tumour-like) surgery followed by anti-infective prophylaxis with albendazole remains one of the key elements. However, most patients with AE are diagnosed at a later stage, when radical surgery (distance of larval to liver tissue of >2cm) cannot be achieved. The backbone of AE treatment remains the continuous medical treatment with albendazole, and if necessary, individualized interventional measures. With this approach, the prognosis can be improved for the majority of patients with AE. The consensus of experts under the aegis of the WHO-IWGE will help promote studies that provide missing evidence to be included in the next update.
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Affiliation(s)
- Enrico Brunetti
- Division of Infectious and Tropical Diseases, University of Pavia, IRCCS S.Matteo Hospital Foundation, WHO Collaborating Center for Clinical Management of Cystic Echinococcosis, 27100 Pavia, Italy.
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Abstract
PURPOSE OF REVIEW Cystic echinococcosis, or cystic hydatidosis, is a complex, chronic disease with a cosmopolitan distribution. In humans, its clinical spectrum ranges from asymptomatic infection to severe, rarely even fatal disease. Four approaches in clinical management exist: surgery, percutaneous techniques and drug treatment for active cysts, and the so-called watch and wait approach for inactive cysts. Allocation of patients to these treatments should be based on cyst stage, size and location, available clinical expertise and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated.We review the currently available evidence for clinical decision-making and discuss ways to improve standards of care of one of the most neglected infectious diseases. RECENT FINDINGS Data are mostly derived from case series and small clinical trials, and treatment guidelines remain at the level of expert opinion. No single high-quality comparative clinical trial of the four treatment options is available to resolve important questions such as stage-specific allocation of treatments, adverse events and long-term relapse rates. Recent work is beginning to acknowledge this problem. SUMMARY Currently, four treatment modalities are available for cystic echinococcosis. The level of evidence on which clinicians have to rely is low. For the time being patients should thus be treated in referral centres. Proper comparative clinical trials are urgently needed.
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