[Spontaneous cutaneous fistula of hydatid liver cysts]

Parietal complication of the hydatid disease: Comprehensive literature review

BACKGROUND

The aim of the study was to provide an overview of the medical literature on parietal complications of hydatid disease (HD).

METHODS

A literature search was conducted on PubMed, Medline, Google Scholar, and Google databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using keywords to identify articles related to parietal complications of HD in the thoracic and abdominal cavities. The following keywords were used: HD, hydatid cyst, cystic echinococcosis, alveolar echinococcosis, abdominal HD, thoracic HD, parietal complication, cutaneous fistulization, cystocutaneous fistulization, cutaneous involvement, external rupture, external fistulization, subcutaneous involvement, and subcutaneous abscess. The language of publication, journal, or country was not included as limitation criteria, and publications dated before August 1, 2016, were considered. Articles or abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management were included in the study, whereas articles with insufficient clinical and demographic data were excluded.

RESULTS

The literature review included 52 articles involving 55 patients with parietal complications of HD. Thirty-two articles were written in English, 15 in French, 2 in Spanish, 1 in Italian, 1 in German and 1 in Russian. All 55 patients (women, 30; men, 23; unknown, 2) involved in the study were aged 7 to 93 (mean ± standard deviation, 54.5 ± 20.2) years. A total of 24 patients had cysto-cutaneous fistula (Echinococcus granulosus), 12 had subcutaneous rupture, 10 had cutaneous fistula (E multilocularis), 3 had cystosubcutaneous abscess, 3 had cysto-cutaneo-bronchial fistula, 2 had cysto-cutaneo-bronchio-biliary fistula, and 1 had cutaneo-bronchial fistula. E granulosus were detected in 43 and E multilocularis in 12 patients through clinical, radiological, or histopathological examinations.

CONCLUSION

Parietal complications such as cysto-cutaneous fistulization are a rare complication of HD. Complicated HD should be considered in the differential diagnosis of patients presenting with cutaneous involvement, especially in HD endemic regions.

Liver hydatid cyst with cutaneous fistulization to the right breast: a case report, management, and literature review

Echinococcus granulosus is the most common tapeworm causing hydatid disease in humans. Its least‐encountered complication is cutaneous fistulization. Omentoplasty, cyst, and fistulous tract drainage revealed successful in the management of this complication. Such intervention can be an alternative when conservative management fails, and a minimally aggressive procedure is required.

Cutaneous fistulization of the hydatid disease: A PRISMA-compliant systematic review

AIM

To provide an overview of the medical literature on cutaneous fistulization in patients with hydatid disease (HD).

METHODS

According to PRISMA guidelines a literature search was made in PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to cutaneous fistulization of the HD. Keywords used were hydatid disease, hydatid cyst, cutaneous fistulization, cysto-cutaneous fistulization, external rupture, and external fistulization. The literature search included case reports, review articles, original articles, and meeting presentations published until July 2016 without restrictions on language, journal, or country. Articles and abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management, were included in the study, whereas articles with insufficient clinical and demographic data were excluded. We also present a new case of cysto-cutaneous fistulization of a liver hydatid cyst.

RESULTS

The literature review included 38 articles (32 full text, 2 abstracts, and 4 unavailable) on cutaneous fistulization in patients with HD. Among the 38 articles included in the study, 22 were written in English, 13 in French, 1 in German, 1 in Italian, and 1 in Spanish. Forty patients (21 males and 19 females; mean age ± standard deviation, 54.0 ± 21.5 years; range, 7-93 years) were involved in the study. Twenty-four patients had cysto-cutaneous fistulization (Echinococcus granulosus); 10 had cutaneous fistulization (E multilocularis), 3 had cysto-cutaneo-bronchio-biliary fistulization, 2 had cysto-cutaneo-bronchial fistulization; and 1 had cutaneo-bronchial fistulization (E multilocularis). Twenty-nine patients were diagnosed with E granulosis and 11 had E multilocularis detected by clinical, radiological, and/or histopathological examinations.

CONCLUSION

Cutaneous fistulization is a rare complication of HD. Complicated HD should be considered in the differential diagnosis of cases presenting with cutaneous fistulization, particularly in regions where HD is endemic.