[Surgical treatment of pulmonary hydatid cysts in childhood]

Predictive Factors of Pulmonary Hydatid Complications in Children

BACKGROUND

Pulmonary echinococcosis in children has frequent and severe complications. The aim of our study was to determine predictive factors of pre and postoperative complications of pediatric pulmonary hydatid cyst.

METHODS

We conducted a retrospective descriptive and analytic study conducted from January 2010 to December 2018. The study population was divided into two groups to determine predictive factors of pre- and post-operative complications of pediatric pulmonary echinococcosis. Data were analyzed by IBM SPSS 21.0. A p-value of 0.05 was accepted as significant.

RESULTS

The study included 106 boys and 94 girls with a median age of 8 years. One hundred and thirty-eight patients (69%) had complicated pulmonary hydatid cyst preoperatively. Univariate analysis identified 12 predictive factors of pre-operative complications: rural origin (p = 0.0001), hydatid contact (p < 0.001), long period between the onset of symptoms and the first medical consultation (p = 0.0001), the autumn and the winter (cold seasons) (p = 0.0001), chest pain (p = 0.0001), hemoptysis (p = 0.023), fever (p = 0.0001), right side (p = 0.01), apical and para hilar location (p = 0.01), superior lobe (p = 0.05), superior right lobe (p = 0.0001), cyst size>5 cm (p = 0.02), positive hydatid serology (p < 0.0001). It identified 2 predictive factors of post-operative complications: giant cyst (p = 0.009) and not performing a capitonnage (p = 0.016). Multivariate analysis showed 4 independent pre-operative predictive factors of complications: rural area (p < 0.0001), fever (p = 0.006), right side (p = 0.02) and positive hydatid serology (p < 0.001). It identified 2 postoperative independent predictive factors of complications: not performing. capitonnage (p = 0.029) and solitary hydatid pulmonary cyst (p = 0.02).

CONCLUSION

Pulmonary hydatid cyst management in children needs a thorough appreciation of independent predictive factors of pre and postoperative complications in order to reduce their morbidity.

Clinical features and treatment of bronchial rupture of pulmonary hydatid cyst in children: a retrospective study of 36 patients

BACKGROUND

The aim of this study was to review the clinical symptoms, radiological data, surgical techniques, and postoperative complications associated with bronchial rupture of pulmonary hydatid cysts in children and evaluate the results of surgical treatment.

MATERIALS AND METHODS

A retrospective study of 40 surgical procedures performed for pulmonary hydatid cyst ruptured in the bronchial tree in 36 children (22 boys and 14 girls), aged between 7 and 18 from January 2009 to December 2019.

RESULTS

The study included 36 patients with a mean age of 14.7. Most symptoms were cough (63.9%), chest pain (38.9%), hemoptysis (33.3%), and hydatid vomiting (22.2%). Chest X-ray, chest CT scan and abdominal echography was performed in all cases. Surgical approach was posterolateral thoracotomy in all cases. Conservative treatment was possible in 35 patients (97.2%) through cystotomy in 25 cases, pericystectomy in 11 cases, and lobar resection in 1 case (2.8%). Average operative time was 103 min (range: 53 and 185 min) and mean postoperative hospital stay was 5.9 days. The postoperative complications occurred in 4 (11.1%): atelectasis (N  =  2), wound site infection (N  =  1), and prolonged air leak (N  =  1). There was no postoperative mortality. After an average follow-up of 39 months there was no recurrence.

CONCLUSION

Ruptured hydatid cyst of the lung into the bronchus. Must be surgically treated and carefully due to the risk of per-operative bronchial flooding. Conservative surgical procedures with precise closure of the bronchial fistulas and capitonnage can complete removal of the cyst with low complications.

A systematic review of the literature on cystic echinococcosis frequency worldwide and its associated clinical manifestations

A systematic literature review of cystic echinoccocosis (CE) frequency and symptoms was conducted. Studies without denominators, original data, or using one serological test were excluded. Random-effect log-binomial models were run for CE frequency and proportion of reported symptoms where appropriate. A total of 45 and 25 articles on CE frequency and symptoms met all inclusion criteria. Prevalence of CE ranged from 1% to 7% in community-based studies and incidence rates ranged from 0 to 32 cases per 100,000 in hospital-based studies. The CE prevalence was higher in females (Prevalence Proportion Ratio: 1.35 [95% Bayesian Credible Interval: 1.16-1.53]) and increased with age. The most common manifestations of hepatic and pulmonary CE were abdominal pain (57.3% [95% confidence interval [CI]: 37.3-76.1%]) and cough (51.3% [95% CI: 35.7-66.7%]), respectively. The results are limited by the small number of unbiased studies. Nonetheless, the age/gender prevalence differences could be used to inform future models of CE burden.