1
|
Decker C, Liu D. Non-Traumatic Hepatobiliary Emergencies. Surg Clin North Am 2023; 103:1171-1190. [PMID: 37838462 DOI: 10.1016/j.suc.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Hepatobiliary emergencies typically present with a constellation of different symptoms including abdominal pain, fevers, nausea, vomiting, jaundice, coagulopathy, and in some instances, encephalopathy. The differential can be broad and may include infectious, inflammatory, and even iatrogenic etiologies. Workup with appropriate lab and imaging studies can help discern between different pathologies and thus guide their management. Interventions can range broadly from conservative management with medical therapy to endoscopic options or surgery. This article explores the diagnostic workup and evaluation as well as the current therapeutic interventions for a variety of these nontraumatic hepatobiliary emergencies based on the most current literature.
Collapse
Affiliation(s)
- Christopher Decker
- Temple University Hospital Department of Surgery, 3401 N. Broad St., Philadelphia, PA 19104, USA.
| | - Dorothy Liu
- Temple University Hospital Department of Surgery, 3401 N. Broad St., Philadelphia, PA 19104, USA
| |
Collapse
|
2
|
Vangelakou K, M. Pitsilka M, Magouliotis D, Zacharoulis D. New Energy Devices in the Treatment of Cystic Echinococcosis. Infect Dis (Lond) 2023. [DOI: 10.5772/intechopen.109372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Treatment of cystic echinococcosis of the liver still remains a debatable subject. The method of choice should aim for the total elimination of the parasite with minimum morbidity and mortality. Different approaches have been proposed. Medical treatment as a monotherapy has been abandoned due to the high chances of recurrence and is mostly used as an adjuvant to surgery or minimally invasive methods. Surgical methods are divided into conservative ones, which include cystectomy and partial pericystectomy, and radical ones, total pericystectomy and hepatectomy. Radical procedures are correlated with lower complication and recurrence rates and, therefore, should be attempted when indications are present. On the other hand, conservative surgery can be the first option in endemic areas, performed by non-specialized general surgeons. The development of laparoscopic techniques made their use a possible alternative approach in selected cases. The use of percutaneous treatments is also quite widespread due to their minimally invasive nature. New energy devices seem to play a significant role in the treatment of cystic echinococcosis, although more studies are needed to establish their efficacy. Observation without intervention is an option for inactive uncomplicated cysts.
Collapse
|
3
|
Abstract
Hepatic alveolar echinococcosis (HAE) is a rare but severe zoonosis caused by the pseudotumoral intrahepatic development of the larval stage of the tapeworm Echinococcus multilocularis. HAE is present only in the Northern Hemisphere, predominantly in China. Currently, there is a significant resurgence of cases in historically endemic areas associated with emergence of HAE in countries not previously concerned. Today, in European countries, HAE is often discovered by chance; however, clinicians should be made aware of opportunistic infections that progressively emerged recently as a result of therapeutic or pathological immunosuppression. Ultrasonography is the key first-line diagnostic procedure, with specific serology providing confirmation in 95% of the cases. Albendazole, only parasitostatic, is the mainstay for treatment. Surgical resection, if feasible, is the gold standard for treatment, and more patients are currently eligible for this option because of an earlier diagnosis. The prognosis has considerably improved but remains poor in countries where access to care is less favorable.
Collapse
Affiliation(s)
- Solange Bresson-Hadni
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland.,Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland.,Laboratory of Parasitology-Mycology, National Reference Center for Echinococcosis, University Hospital of Besançon, Besançon, France
| | - Laurent Spahr
- Gastroenterology and Hepatology, Faculty of Medicine, University Hospitals of Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University Hospitals of Geneva, Faculty of Medicine, Switzerland
| |
Collapse
|
4
|
Shalayiadang P, Abulizi A, Ahan A, Jiang T, Ran B, Zhang R, Guo Q, Wen H, Shao Y, Aji T. Diagnosis and treatment modalities of hilar biliary duct stricture in hepatic cystic echinococcosis after endocystectomy. ACTA ACUST UNITED AC 2021; 28:51. [PMID: 34142953 PMCID: PMC8212812 DOI: 10.1051/parasite/2021051] [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] [Received: 02/26/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
Abstract
Aim: Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities. Methods: Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up. Results: Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient. Conclusion: Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.
Collapse
Affiliation(s)
- Paizula Shalayiadang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Abduaini Abulizi
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Ayifuhan Ahan
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Tiemin Jiang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Bo Ran
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Ruiqing Zhang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Qiang Guo
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Hao Wen
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China - State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Yingmei Shao
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| | - Tuerganaili Aji
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, 830054 Urumqi, Xinjiang, PR China
| |
Collapse
|
5
|
Wan L, Ran B, Aji T, Shalayiadang P, Jiang T, Shao Y, Wen H. Laparoscopic hepatectomy for the treatment of hepatic alveolar echinococcosis. ACTA ACUST UNITED AC 2021; 28:5. [PMID: 33439119 PMCID: PMC7805388 DOI: 10.1051/parasite/2021001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
Background: At present, laparoscopy is relatively mature as a minimally invasive technique, but there are few reports on this approach for the radical treatment of hepatic alveolar echinococcosis (AE). In this study, we aimed to evaluate the safety and feasibility of laparoscopic hepatectomy (LH) for AE treatment. Results: A retrospective review of medical records obtained from 13 patients diagnosed with AE between January 2018 and December 2019 and treated with laparoscopic hepatectomy was conducted at the First Affiliated Hospital of Xinjiang Medical University. All patients (n = 13) underwent hepatic resection using laparoscopy and none were transferred to open surgery. The average duration of surgery was 285 min (145–580 min). Intraoperative bleeding was 305 mL (20–2000 mL). The mean duration of postoperative catheterization was 6.9 days (3–21 days), and postoperative hospital stay was 7.2 days (4–14 days). No complication of Clavien-Dindo grade III or above occurred, except for the second patient with acute liver failure post-surgically. No recurrences or deaths were observed at 9–30 months of follow-up. Conclusions: Laparoscopic hepatectomy appears to be safe and effective in selected AE patients. The advantages of this technique for AE treatment need to be further compared with the classical open approach.
Collapse
Affiliation(s)
- Li Wan
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, 830011 Urumqi, PR China
| | - Bo Ran
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Tuerganaili Aji
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Paizula Shalayiadang
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Tiemin Jiang
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Yingmei Shao
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - Xinjiang Hydatid & Hepatobiliary Surgery Medical Centre, 830054 Urumqi, PR China
| | - Hao Wen
- Department of Hepatobiliary & Hydatid, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, 830011 Urumqi, PR China - State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, 830011 Urumqi, PR China
| |
Collapse
|
6
|
Vuitton DA, McManus DP, Rogan MT, Romig T, Gottstein B, Naidich A, Tuxun T, Wen H, Menezes da Silva A. International consensus on terminology to be used in the field of echinococcoses. ACTA ACUST UNITED AC 2020; 27:41. [PMID: 32500855 PMCID: PMC7273836 DOI: 10.1051/parasite/2020024] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
Echinococcoses require the involvement of specialists from nearly all disciplines; standardization of the terminology used in the field is thus crucial. To harmonize echinococcosis terminology on sound scientific and linguistic grounds, the World Association of Echinococcosis launched a Formal Consensus process. Under the coordination of a Steering and Writing Group (SWG), a Consultation and Rating Group (CRG) had the main missions of (1) providing input on the list of terms drafted by the SWG, taking into account the available literature and the participants’ experience; and (2) providing independent rating on all debated terms submitted to vote. The mission of the Reading and Review Group (RRG) was to give an opinion about the recommendation paper in terms of readability, acceptability and applicability. The main achievements of this process were: (1) an update of the current nomenclature of Echinococcus spp.; (2) an agreement on three names of diseases due to Echinococcus spp.: Cystic Echinococcosis (CE), Alveolar Echinococcosis (AE) and Neotropical Echinococcosis (NE), and the exclusion of all other names; (3) an agreement on the restricted use of the adjective “hydatid” to refer to the cyst and fluid due to E. granulosus sensu lato; and (4) an agreement on a standardized description of the surgical operations for CE, according to the “Approach, cyst Opening, Resection, and Completeness” (AORC) framework. In addition, 95 “approved” and 60 “rejected” terms were listed. The recommendations provided in this paper will be applicable to scientific publications in English and communication with professionals. They will be used for translation into other languages spoken in endemic countries.
Collapse
Affiliation(s)
- Dominique A Vuitton
- National French Reference Centre for Echinococcosis, University Bourgogne Franche-Comté and University Hospital, FR-25030 Besançon, France
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, AU-4006 Brisbane, Queensland, Australia
| | - Michael T Rogan
- Department of Biology and School of Environment & Life Sciences, University of Salford, GB-M5 4WT Manchester, United Kingdom
| | - Thomas Romig
- Department of Parasitology, Hohenheim University, DE-70599 Stuttgart, Germany
| | - Bruno Gottstein
- Institute of Parasitology, School of Medicine and Veterinary Medicine, University of Bern, CH-3012 Bern, Switzerland
| | - Ariel Naidich
- Department of Parasitology, National Institute of Infectious Diseases, ANLIS "Dr. Carlos G. Malbrán", AR-1281 Buenos Aires, Argentina
| | - Tuerhongjiang Tuxun
- WHO Collaborating Centre for Prevention and Care Management of Echinococcosis and State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, CN-830011 Urumqi, PR China
| | - Hao Wen
- WHO Collaborating Centre for Prevention and Care Management of Echinococcosis and State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, CN-830011 Urumqi, PR China
| | - Antonio Menezes da Silva
- Past-President of the World Association of Echinococcosis, President of the College of General Surgery of the Portuguese Medical Association, PT-1649-028 Lisbon, Portugal
| | | |
Collapse
|
7
|
Aljaber NN, Alshoabi SA, Qurashi AA, Daqqaq TS. Cardiac hydatid cyst in the right ventricle: An unusual case at a rare site. J Taibah Univ Med Sci 2020; 15:249-252. [PMID: 32647522 PMCID: PMC7336018 DOI: 10.1016/j.jtumed.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 12/29/2022] Open
Abstract
Hydatid disease is a parasitic infection by the larval stage of the tapeworm Echinococcus granulosus. It affects liver, lungs and rarely other organs. Medical imaging provide the basis for diagnosis. This case report describes an extremely rare location of cardiac hydatid cyst in the right ventricle of the heart. We describe a 23-year-old woman who presented with shortness of breath and productive cough. Laboratory investigations showed marked eosinophilia and anemia. Chest radiography and abdominal ultrasonography were unremarkable. Cardiac computed tomography (CT) identified two well-defined fluid densities in the right ventricle without contrast enhancement. A transthoracic echocardiography (TTE) showed two cystic lesions in the right ventricular cavity that was attached to the interventricular septum. Hydatid cyst was the most likely diagnosis followed by the possibility of a congenital cardiac cyst. An open-heart surgery with cardiac cystectomy was performed. Post-operative analysis of the resected specimens showed multiple hydatid cysts with living scolices of Echinococcus granulosus. The patient recovered uneventfully and was discharged on oral albendazole.
Collapse
Affiliation(s)
- Nouradden N Aljaber
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Republic of Yemen
| | - Sultan A Alshoabi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, KSA
| | - Abdulaziz A Qurashi
- Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, KSA
| | - Tareef S Daqqaq
- Department of Radiology, Faculty of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| |
Collapse
|
8
|
Milosavljevic V, Veselinovic M, Tadic B, Galun D, Ceranic M, Eric D, Bjelovic M. Laparoscopic Management of Initially Unrecognized Splenic Hydatid Cysts: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2019; 55:medicina55120771. [PMID: 31817008 PMCID: PMC6956320 DOI: 10.3390/medicina55120771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/03/2022]
Abstract
We present a case report that demonstrates diagnostic and intraoperative challenges in the laparoscopic management of initially unrecognized splenic hydatid disease. A male patient, aged 44, was admitted to our department with a big unilocular splenic cyst, radiologically (ultrasonography, computed tomography) characterized as a simple cyst. Serological tests for anti-Echonococcus antibody were negative, and chests X-ray findings were unremarkable, so laparoscopic cyst fenestration with omentoplasty was planned. The intraoperative finding did not correspond to a simple splenic cyst. Hydatid daughter cysts were recognized after the careful opening of the cyst wall. The operation was completed without shifting to open procedures. Laparoscopic partial pericystectomy with omentoplasty is a safe and effective surgical procedure for the management of splenic hydatid disease.
Collapse
Affiliation(s)
| | - Milan Veselinovic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Boris Tadic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-62-388-288
| | - Danijel Galun
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Miljan Ceranic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Dragan Eric
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| | - Milos Bjelovic
- Clinical Centre of Serbia, Clinic for Digestive Surgery, 11000 Belgrade, Serbia
| |
Collapse
|
9
|
Shaheen HAAAS, El-Ahl SAHS, Raouf AMA, El-Dardiry MA, Badawi MA, Aal AAA. Ultrastructural changes in hydatid cyst walls obtained from human cases, exposed to different therapeutic approaches. Parasitol Res 2019; 118:3149-3157. [PMID: 31578608 DOI: 10.1007/s00436-019-06446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
Recurrence of cystic echinococcosis as a result of treatment failure is frequently reported to cause a major problem in management of such serious parasitic infection. The deeply seated innermost germinal layer of hydatid cysts is a relatively delicate layer, yet responsible for viability maintenance of this parasitic stage. In this study, a trial was done to explore the ultrastructural changes in germinal and laminated layer of the hydatid cyst for the first time in human cases exposed to different therapeutic approaches which were done earlier to the final open surgical intervention. Four groups were included: group 1 did not receive any earlier form of treatment; group 2 was previously treated with only medical therapy; group 3 was treated with a single course of medical treatment, plus a single PAIR technique; group 4 was treated with multiple courses of medical treatment plus multiple PAIR techniques. Complete alteration of ultrastructural features of germinal and laminated layers were observed only with samples from group 4, indicating a kind of failure of the therapeutic approaches used in group, 1, 2, and 3, unless repeated in group 4 to achieve a real change regarding the fitness of the parasitic cystic lesions. Searching for more effective, safe, therapeutic method is highly recommended which may end the suffering of the affected patients.
Collapse
Affiliation(s)
| | | | - Amr Mahmoud Abdel Raouf
- Surgery Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Marwa Ahmed El-Dardiry
- Department of Medical Parasitology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | - Manal A Badawi
- Department of Pathology, National Research Institute, Giza, Egypt
| | - Amany Ahmed Abdel Aal
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Giza, Egypt.,Department of Medical Parasitology, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| |
Collapse
|
10
|
Should Pediatricians Be Aware of Cystic Echinococcosis? A Literature Review. J Pediatr Gastroenterol Nutr 2019; 69:e120. [PMID: 31348123 DOI: 10.1097/mpg.0000000000002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
11
|
Sen P, Demirdal T, Nemli SA. Evaluation of clinical, diagnostic and treatment aspects in hydatid disease: analysis of an 8-year experience. Afr Health Sci 2019; 19:2431-2438. [PMID: 32127814 PMCID: PMC7040281 DOI: 10.4314/ahs.v19i3.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background & Objective Echinococcosis is still a common health problem. The aim of this study was to discuss our 8-year data in terms of diagnosis, treatment and follow-up of cystic Echinococcosis. Methods A total of 178 patients who had hydatid cyst were analyzed retrospectively from the hospital records. The diagnosis of hydatid cyst was based on clinical-serological and radiological findings. Treatment response was evaluated with clinical, radiological and serological findings. Results A total of 178 medical records were evaluated; the male:female ratio was 0.73 and mean age 44.6±16.9 years. The most common symptom was abdominal pain (94, 52.8%). The mean cyst size was 9.5±3.9 cm. Eosinophilia was significantly higher in patients with complicated cyst (35.3%) (p=0.002). The average duration of hospitalization in surgical patients was shorter than non-surgical patients (p=0.026). There was no significant correlation between the preference of scolicidal agent (hypertonic saline, H2O2, povidone iodine) and recurrence in patients who underwent surgery (p>0.05). There was no significant difference between the patients who underwent radical and conservative surgery in terms of complication and recurrence (p=0.077, p=0.557). No significant difference was found between percutaneous and surgical treatment in terms of complication and recurrence (p=0.264, p=0.276). Conclusion Even though considerable progress has been made, uncertainties remain in the diagnosis and treatment of Echinococcosis. Hence, standardized diagnostic and treatment procedures should be established with well-designed studies.
Collapse
|
12
|
Surgical approaches for definitive treatment of hepatic alveolar echinococcosis: results of a survey in 178 patients. Parasitology 2019; 146:1414-1420. [DOI: 10.1017/s0031182019000891] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractHepatic alveolar echinococcosis (HAE) is a potentially fatal disease caused by the larval growth of Echinococcus multilocularis. We analysed the clinical data of 178 consecutive HAE patients treated with definitive radical surgery at our institution. According to the surgical approach: group A patients underwent direct radical hepatic resection; group B patients first underwent percutaneous puncture external drainage, followed by radical hepatic resection 2 months later; group C patients underwent a two-step hepatic resection; and group D patients underwent liver transplantation. The baseline characteristics, mortality, postoperative complications and recurrence rates were evaluated. Symptoms were present in 79.8% (142/178) patients. Bi-lobar lesion was found in 34 (19.1%, 34/178) patients, 47.2% (84/178) of whom had ⩾2 lesions each. There were no intraoperative deaths. The postoperative mortality was 2.29% in group A, 8.62% in group D and 0% in groups B and C. The main cause of death was a serious postoperative complication (Clavien–Dindo grades III–V). Patients were followed-up systematically for a median of 35.8 months (8–72) without recurrence. Active HAE should be treated by radical liver resection, and the complicated alveolar echinococcosis of the liver has been managed whenever possible using principles of radical liver resection by experienced hepatic surgeons.
Collapse
|
13
|
Velasco-Tirado V, Romero-Alegria A, Pardo-Lledías J, Alonso-Sardón M, Lopez-Bernus A, Sampedro JQ, Bellvis LM, Iglesias Gomez A, Muro A, Muñoz Bellido JL, Iglesias-Iglesias M, Jimenez Lopez MF, Belhassen-García M. Management of cystic echinococcosis in the last two decades: what have we learned? Trans R Soc Trop Med Hyg 2019; 112:207-215. [PMID: 29897552 DOI: 10.1093/trstmh/try050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/05/2018] [Indexed: 12/12/2022] Open
Abstract
Background Management options for cystic echinococcosis (CE) remain a serious problem. The main aim of this study was to examine the selection and complications of treatment applied in patients with CE. The second aim was to evaluate the mortality rate and causative factors. Methods A retrospective descriptive study of patients diagnosed with CE between 1998 and 2015 was conducted, according to ICD-9 (code 122·0 to 122·9) criteria in the Complejo Asistencial Universitario of Salamanca, Spain. Results Four-hundred-ninety-one (491) patients were diagnosed with CE disease and the treatment applied in these patients were: 166 (33.8%) patients received only surgery, 176 (35.8%) surgery and drugs, 17 (3.5%) drugs alone, in 131 (26.7%) patients the strategy was 'watch and wait', and only one patient (0.2%) was applied puncture-aspiration-injection-respiration (PAIR). Thus, a total of 342 patients received surgery, either alone (166) or combined with drugs (176), and a total of 193 (39.4%) patients were medically treated, either alone (17) or combined with surgery (176); 123 (63.7%) patients used albendazole alone; and 70 (36.3%) patients used a combination of albendazole and praziquantel. Sixty-five patients (19.0%) had complications after surgery and seven of them (2%) died. Only 15 (7.8%) cases had side effects from anthelmintics. Throughout the study period, 80 (16.3%) patients died, 14 (2.9%) of them due to CE disease. Conclusions Complications of CE are one of the most common causes of mortality in CE patients, with size, location, and number of cysts, and the 'watch and wait' treatment strategy being the main factors associated with mortality.
Collapse
Affiliation(s)
- Virginia Velasco-Tirado
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, Salamanca.,Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Área de Medicina Preventiva y Salud Pública, Universidad de Salamanca, Facultad de Medicina, Campus Miguel de Unamuno s/n, Salamanca
| | - Angela Romero-Alegria
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca.,Servicio de Medicina Interna, Complejo Asistencial Universitario de Salamanca (CAUSA), Paseo de San Vicente 58-182, Salamanca
| | - Javier Pardo-Lledías
- Servicio de Medicina Interna, Hospital General de Palencia 'Río Carrión', C/Donantes de Sangre s/n., Palencia.,Servicio de Medicina Interna. Hospital Marqués de Valdecilla. Avenida Vadecilla 25, Santander
| | - Montserrat Alonso-Sardón
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Área de Medicina Preventiva y Salud Pública, Universidad de Salamanca, Facultad de Medicina, Campus Miguel de Unamuno s/n, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca
| | - Amparo Lopez-Bernus
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca.,Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, Paseo de San Vicente 58-182, Salamanca
| | - Jose Quiñones Sampedro
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Servicio de Cirugía, Complejo Asistencial Universitario de Salamanca (CAUSA) Paseo de San Vicente 58-182, Salamanca
| | - Luis Muñoz Bellvis
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Servicio de Cirugía, Complejo Asistencial Universitario de Salamanca (CAUSA) Paseo de San Vicente 58-182, Salamanca
| | - Alicia Iglesias Gomez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca.,Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, Paseo de San Vicente 58-182, Salamanca
| | - Antonio Muro
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca.,Laboratorio de Inmunología Parasitaria y Molecular, Facultad de Farmacia, Universidad de Salamanca, Campus Miguel de Unamuno s/n, Salamanca
| | - Juan Luis Muñoz Bellido
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca.,Servicio de Microbiología, CAUSA, Paseo de San Vicente 58-182, Salamanca.,Grupo de Investigacion Reconocido MICRAPE, Departamento de Ciencias Biomedicas y del Diagnostico, Universidad de Salamanca, Campus Miguel de Unamuno s/n, Salamanca
| | - Manuel Iglesias-Iglesias
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Servicio de Cirugía, Complejo Asistencial Universitario de Salamanca (CAUSA) Paseo de San Vicente 58-182, Salamanca
| | - Marcelo Fernando Jimenez Lopez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Servicio de Cirugía Toracica, Complejo Asistencial Universitario de Salamanca (CAUSA) Paseo de San Vicente 58-182, Salamanca, Spain
| | - Moncef Belhassen-García
- Instituto de Investigación Biomédica de Salamanca (IBSAL), CAUSA, Hospital Virgen de la Vega 10° planta, Paseo de San Vicente 58-182, Salamanca.,Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Universidad de Salamanca, Facultad de Farmacia, Area de Parasitología, Campus Miguel de Unamuno s/n, Salamanca.,Servicio de Medicina Interna, Sección de Enfermedades Infecciosas, CAUSA, Paseo de San Vicente 58-182, Salamanca
| |
Collapse
|
14
|
Kuscher S, Kronberger IE, Loizides A, Plaikner M, Ninkovic M, Brunner A, Auer H, Gassner EM, Öfner D, Schneeberger S. Exploring the limits of hepatic surgery for alveolar echinococcosis—10-years’ experience in an endemic area of Austria. Eur Surg 2019. [DOI: 10.1007/s10353-019-0596-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
15
|
Wen H, Vuitton L, Tuxun T, Li J, Vuitton DA, Zhang W, McManus DP. Echinococcosis: Advances in the 21st Century. Clin Microbiol Rev 2019; 32:e00075-18. [PMID: 30760475 PMCID: PMC6431127 DOI: 10.1128/cmr.00075-18] [Citation(s) in RCA: 476] [Impact Index Per Article: 95.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Echinococcosis is a zoonosis caused by cestodes of the genus Echinococcus (family Taeniidae). This serious and near-cosmopolitan disease continues to be a significant public health issue, with western China being the area of highest endemicity for both the cystic (CE) and alveolar (AE) forms of echinococcosis. Considerable advances have been made in the 21st century on the genetics, genomics, and molecular epidemiology of the causative parasites, on diagnostic tools, and on treatment techniques and control strategies, including the development and deployment of vaccines. In terms of surgery, new procedures have superseded traditional techniques, and total cystectomy in CE, ex vivo resection with autotransplantation in AE, and percutaneous and perendoscopic procedures in both diseases have improved treatment efficacy and the quality of life of patients. In this review, we summarize recent progress on the biology, epidemiology, diagnosis, management, control, and prevention of CE and AE. Currently there is no alternative drug to albendazole to treat echinococcosis, and new compounds are required urgently. Recently acquired genomic and proteomic information can provide a platform for improving diagnosis and for finding new drug and vaccine targets, with direct impact in the future on the control of echinococcosis, which continues to be a global challenge.
Collapse
Affiliation(s)
- Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
| | - Lucine Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis and French National Centre for Echinococcosis, University Bourgogne Franche-Comte and University Hospital, Besançon, France
| | - Tuerhongjiang Tuxun
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dominique A Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis and French National Centre for Echinococcosis, University Bourgogne Franche-Comte and University Hospital, Besançon, France
| | - Wenbao Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Balen Topić M, Skuhala T, Desnica B, Višković K, Drinković M. Repeated Percutaneous Treatment of Massive Hepatic Cystic Echinococcosis in a Child. Pediatrics 2018; 142:peds.2018-1254. [PMID: 30429271 DOI: 10.1542/peds.2018-1254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
Because of mostly asymptomatic cyst growth and often-neglected nonspecific low-grade symptoms, many cases of cystic echinococcosis (CE) caused by Echinococcus granulosus in the pediatric population are diagnosed at school age, in an advanced and even complicated stage. In 2003, after 5 months of intermittent dull upper-right abdominal pain and nausea, a 13-year-old boy was diagnosed with massive liver CE, with ∼20 round-shaped double-walled medium-sized infective cysts, which permeated the whole liver. Because of their wide distribution across the liver tissue and the risky superficial position of some cysts, liver transplantation emerged as the optimal therapeutic option. Despite being described as only an exceptionally used method for CE, we subjected our patient on 4 occasions to a radiofrequency energy thermoablation (RFT) procedure similar to the one used for malignant neoplasms. In total, 9 superficially situated cysts were initially treated with RFT by using a 14-gauge outer needle and a temperature of 70°C for 8 minutes per cyst, and the remaining cysts were treated with the puncture-aspiration-instillation-reaspiration procedure, along with albendazole (15 mg/kg per day) therapy, for a period of 20 months. After 2 years of follow-up, 4 residual small-sized semisolidified cysts were seen in the liver, and the patient showed no signs of relapse. Although not routinely used, RFT, along with puncture-aspiration-instillation-reaspiration and prolonged albendazole therapy, has shown good tolerability and long-term efficacy in the treatment of multiple infective CE, which could suggest the usefulness of the RFT method beyond salvage situations in pediatric patients.
Collapse
Affiliation(s)
- Mirjana Balen Topić
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia; .,Department of Infectious Diseases, School of Medicine and
| | - Tomislava Skuhala
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia.,Department of Infectious Diseases, School of Dental Medicine, University of Zagreb, Zagreb, Croatia; and
| | - Boško Desnica
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia
| | - Klaudija Višković
- University Hospital for Infectious Diseases Dr Fran Mihaljević, Zagreb, Croatia
| | | |
Collapse
|
17
|
High-intensity focused ultrasound ablation: a non-surgical approach to treat advanced and complicated liver alveococcosis. J Med Ultrason (2001) 2018; 46:251-255. [PMID: 30353443 DOI: 10.1007/s10396-018-0914-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
Liver alveococcosis is a life-threatening parasitic disease with progressive growth and wide metastasis to neighboring tissues, lungs, and brain. The radical treatment option is surgery along with a few chemical therapies. However, the frequency of progression and recurrence, as well as postoperative complications and mortality, remains very high. The high-intensity focused ultrasound (HIFU) treatment system, a therapeutic application using ultrasound to deliver heat or agitation into the body, was initially designed to treat cancer. Advanced and complicated forms of liver alveococcosis usually require surgical treatment to provide partial ectomy of necrotized liver tissue along with alveococcal caverns and sanitation of the peritoneal cavity. In this article, we presented a case of successful HIFU ablation with transhepatic puncture and drainage in treatment of complicated and advanced liver alveococcosis to avoid wide surgical treatment.
Collapse
|
18
|
Brunetti E, Tamarozzi F, Macpherson C, Filice C, Piontek MS, Kabaalioglu A, Dong Y, Atkinson N, Richter J, Schreiber-Dietrich D, Dietrich CF. Ultrasound and Cystic Echinococcosis. Ultrasound Int Open 2018; 4:E70-E78. [PMID: 30364890 PMCID: PMC6199172 DOI: 10.1055/a-0650-3807] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/25/2018] [Accepted: 06/18/2018] [Indexed: 02/08/2023] Open
Abstract
The introduction of imaging techniques in clinical practice 40 years ago changed the clinical management of many diseases, including cystic echinococcosis (CE). For the first time cysts were clearly seen before surgery. Among the available imaging techniques, ultrasound (US) has unique properties that can be used to study and manage cystic echinococcosis. It is harmless, can image almost all organs and systems, can be repeated as often as required, is portable, requires no patient preparation, is relatively inexpensive and guides diagnosis, treatment and follow-up without radiation exposure and harm to the patient. US is the only imaging technique which can be used in field settings to assess CE prevalence because it can be run even on solar power or a small generator in remote field locations. Thanks to US classifications, the concept of stage-specific treatments was introduced and because US is repeatable, the scientific community has gained a clearer understanding of the natural history of the disease. This paper reviews the scope of US in CE, describes its strengths and weaknesses compared to other imaging techniques and its relationship with serodiagnosis and discusses sonographic features that may be helpful in differential diagnosis.
Collapse
Affiliation(s)
- Enrico Brunetti
- San Matteo Hospital Foundation, University of Pavia, Unit of Infectious and Tropical Diseases, Pavia, Italy
| | - Francesca Tamarozzi
- Center for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | | | - Carlo Filice
- San Matteo Hospital Foundation, University of Pavia, Unit of Infectious and Tropical Diseases, Pavia, Italy
| | - Markus Schindler Piontek
- Caritas Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Medical Clinic 2, Bad Mergentheim, Germany
| | | | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Nathan Atkinson
- John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Department of Gastroenterology, Oxford, New Zealand
| | - Joachim Richter
- Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany
| | | | | |
Collapse
|
19
|
Dagoglu-Kartal MG, Ciftci T, Ozer C, Akinci D, Akhan O. Case Report: Role of Interventional Radiology in the Management of Patients with Alveolar Echinococcus: Successful Management of Three Cases. Am J Trop Med Hyg 2018; 98:1403-1407. [PMID: 29611496 DOI: 10.4269/ajtmh.17-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Alveolar echinococcus (AE) is an infestation by Echinococcus multilocularis. Partial hepatectomy or liver transplantation is the first choice of treatment. However, the disease is usually diagnosed at an unresectable stage. In those cases, invasion of the bile ducts and vessels, and necrosis in the center of the lesion lead to severe complications, such as cholangitis and liver abscesses. Palliative surgery has been reported to not offer advantages in management, and percutaneous and endoscopic interventions have become more prominent in management. In this case series, outcomes in three cases with unresectable AE were reported. In one of the cases, interventional procedures were used to manage the complications after surgery. In the second case, the cystic component was aspirated to decrease the size before the surgery and in the third case, it was used to drain biliary tree and no surgery was done.
Collapse
Affiliation(s)
| | - Turkmen Ciftci
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Cigdem Ozer
- Numune Training and Research Hospital Radiology Clinic, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Okan Akhan
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| |
Collapse
|
20
|
Chen KF, Tang YY, Wang R, Fang D, Chen JH, Zeng Y, Li B, Wen TF, Wang WT, Wu H, Xu MQ, Yang JY, Wei YG, Huang JW, Li JX, Zhang HZ, Feng X, Yan LN, Chen ZY. The choose of different surgical therapies of hepatic alveolar echinococcosis: A single-center retrospective case-control study. Medicine (Baltimore) 2018; 97:e0033. [PMID: 29465544 PMCID: PMC5841995 DOI: 10.1097/md.0000000000010033] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to evaluate different surgical therapies for hepatic alveolar echinococcosis in different clinical stages.We analyze the clinical data of 115 patients who received surgical treatment in West China Hospital from January 2004 to June 2016. Among these patients, 77 cases underwent radical hepatic resection (group A, n = 77); 17 cases underwent palliative resection (group B, n = 17), and 21 cases underwent liver transplantation (group C, n = 21) with 12 cases of orthotopic liver transplantation and 9 cases of liver autotransplantation.The postoperative complication rate of radical hepatic resection group was 13.0% (10/77), which is statistically significant (P < .05) than the rate of palliative resection group 29.4% (5/17) or liver transplantation group 23.8% (5/21). The follow-up period ranged from 1 to 72 months. The overall median survival rate of radical resection was 72/77, higher than the rate of palliative group (12/17) or transplantation group (17/21), which was also statistically significant (P < .01).In our study, we believe in that all stages of hepatic alveolar echinococcosis should take active surgical interventions, and radical hepatic resection should be considered as the first-choice treatment for early stage of alveolar echinococcosis, while palliative surgery is still helpful to relieve symptoms and improve the life quality for advanced patients. Liver transplantation might also be an alternative option for the late-stage hepatic alveolar echinococcosis.
Collapse
Affiliation(s)
- Ke-fei Chen
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - You-yin Tang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Rui Wang
- Molecular Pharmacology and Chemistry Program, Memorial Sloan-Kettering Cancer Center, New York, NY 10065
| | - Dan Fang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Jun-Hua Chen
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Yong Zeng
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Bo Li
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Tian-fu Wen
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Wen-tao Wang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Hong Wu
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Ming-qing Xu
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Jia-yin Yang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Yong-gang Wei
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Ji-wei Huang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Jia-xin Li
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Han-zhi Zhang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Xi Feng
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Lü-nan Yan
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
| | - Zhe-yu Chen
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu
- Institute of hydatid disease prevention and control, Ganze prefecture, Sichuan Province, China
| |
Collapse
|
21
|
|
22
|
Superinfection of a Dead Hepatic Echinococcal Cyst with a Cutaneous Fistulization. Case Rep Radiol 2017; 2017:9393462. [PMID: 29181218 PMCID: PMC5664247 DOI: 10.1155/2017/9393462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/06/2017] [Accepted: 09/26/2017] [Indexed: 12/28/2022] Open
Abstract
Cystic echinococcosis (CE), also known as "hydatid disease" (HD), is a zoonotic infection caused by the larval stage of Echinococcus granulosus, which infects humans as intermediate hosts through the orofecal route. Carried by the intestinal venous blood, the embryos released by the eggs of the tapeworms can reach every organ, especially the liver, turning into a hydatid cyst. Usually asymptomatic, the cysts can be incidentally detected through radiological examinations performed for other reasons. We show an unusual case of superinfection of a hydatid cyst with typical radiological features of inactivity (WHO-type CE5) with an even rarer skin fistulization passing through a subcutaneous-abdominal abscess involving the right iliac muscle.
Collapse
|
23
|
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
Collapse
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
| |
Collapse
|
24
|
Sharp G, Yeo D, Koh C. Presentation of secondary parasitic infection 37 years after primary infection. J Surg Case Rep 2017; 2017:rjx103. [PMID: 28630663 PMCID: PMC5470090 DOI: 10.1093/jscr/rjx103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/09/2017] [Indexed: 12/04/2022] Open
Abstract
Echinococcus granulosus (EG) is a neglected pathology that causes cystic echinococcosis and primarily affects the liver and lung. EG infects ~6 million worldwide and mortality is quoted as 2-4% per 100 000 inhabitants. The increase in human traffic from endemic regions demands clinician's awareness. Dogs are the most common definitive host for the EG tapeworm. Human infection requires ingestion of fecal parasitic eggs. Primary infection causes cysts to appear in affected organs, rupture of which leads to secondary infection. Ultrasound remains the mainstay of diagnosis. Treatment can be either; chemotherapeutic, radiological, surgical or a combination depending on the organ affected.
Collapse
Affiliation(s)
- Gary Sharp
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David Yeo
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Cherry Koh
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
25
|
Zhang R, Aji T, Shao Y, Jiang T, Yang L, Lv W, Chen Y, Chen X, Wen H. Nanosecond pulsed electric field (nsPEF) disrupts the structure and metabolism of human Echinococcus granulosus protoscolex in vitro with a dose effect. Parasitol Res 2017; 116:1345-1351. [PMID: 28236173 DOI: 10.1007/s00436-017-5412-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/14/2017] [Indexed: 01/28/2023]
Abstract
The number of interventional treatments for hepatic cystic echinococcosis is increasing, but the chemicals or high temperatures used in these methodologies cause biliary complications, thus limiting their clinical applications. This experimental study aimed to apply a novel, non-thermal, non-chemical ablation method termed nanosecond pulsed electric field (nsPEF) for the treatment of human hepatic cystic echinococcosis. The nsPEF treatment parameters against protoscolices from human hepatic cystic echinococcosis were optimized in vitro. The efficacy and mechanism of nsPEF treatment were also investigated. Fresh protoscolices were isolated from human hepatic cystic echinococcosis and were exposed to 300 ns of nsPEF with different field strengths (0, 7, 14, 21, and 29 kV/cm) and pulse numbers (50 and 100 pulses). Then, the viability of the nsPEF-treated protoscolices was evaluated in vitro. Morphological and ultra-structural changes were visualized with H&E staining and scanning electron microscopy. The membrane enzyme activity of alkaline phosphatase (AP) and gamma-glutamyl-transpeptidase (GGT) was measured. nsPEF caused dose-dependent protoscolex death. One-hundred pulses of nsPEF at 21 kV/cm or higher caused a significant increase in the death rate of protoscolices. nsPEF induced significant lethal damage with 50 pulses at 21 or 29 kV/cm and with 100 pulses at 14, 21, or 29 kV/cm, accompanied by morphological destruction and increased levels of AP and GGT membrane enzymes. Thus, nsPEF induced dose-dependent protoscolex mortality and caused destruction of protoscolices and increased membrane enzymes. The mechanism may involve direct damage to the membrane structures of the protoscolices, promoting enzyme exhaustion and disruption of metabolism.
Collapse
Affiliation(s)
- Ruiqing Zhang
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, #137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - Tuerganaili Aji
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, #137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - Yingmei Shao
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, #137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - Tiemin Jiang
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, #137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - Lei Yang
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, #137 Liyushan Road, Urumqi, Xinjiang, 830054, China
| | - Weimin Lv
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Zhejiang, Hangzhou, 310003, China
| | - Yonggang Chen
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Zhejiang, Hangzhou, 310003, China
| | - Xinhua Chen
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Zhejiang, Hangzhou, 310003, China.
| | - Hao Wen
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, #137 Liyushan Road, Urumqi, Xinjiang, 830054, China.
| |
Collapse
|
26
|
Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, Vuitton DA. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. ADVANCES IN PARASITOLOGY 2017; 96:259-369. [PMID: 28212790 DOI: 10.1016/bs.apar.2016.09.006] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.
Collapse
Affiliation(s)
- P Kern
- University Hospital of Ulm, Ulm, Germany
| | | | - O Akhan
- Hacettepe University, Ankara, Turkey
| | - B Müllhaupt
- University Hospital of Zurich, Zürich, Switzerland
| | - K A Vizcaychipi
- National Institute of Infectious Diseases, Buenos Aires, Argentina
| | - C Budke
- Texas A&M University, College Station, TX, United States
| | - D A Vuitton
- Université de Franche-Comté, Besançon, France
| |
Collapse
|
27
|
Ambregna S, Koch S, Sulz MC, Grüner B, Öztürk S, Chevaux JB, Sulima M, de Gottardi A, Napoléon B, Abergel A, Bichard P, Boytchev I, Deprez P, Dumortier J, Frossard JL, Kull E, Meny B, Moradpour D, Prat F, Vanbiervliet G, Thevenot T, Vuitton DA, Bresson-Hadni S, Vuitton L. A European survey of perendoscopic treatment of biliary complications in patients with alveolar echinococcosis. Expert Rev Anti Infect Ther 2016; 15:79-88. [PMID: 27788612 DOI: 10.1080/14787210.2017.1252260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary complications represent a turning point in the course of Alveolar Echinococcosis (AE). We conducted a European survey to collect data on the current usage and results of perendoscopic interventions (PEIs) for their treatment. METHODS Patient's characteristics and follow-up until January 31st, 2015 were recorded using an online questionnaire. RESULTS From 18 centers 129 PEIs were analyzed in 38 patients; 139 plastic stents were inserted during 85 PEIs; median time between stent placements was significantly longer when 3 stents or more were placed. Initial symptoms disappeared in 95% and long-term bile duct patency was obtained in 73% of cases. Cholangitis was a more frequent complication of the PEIs (10%) than in other indications; intensive lavage of the bile ducts may prevent this complication. CONCLUSION European centers use perendoscopic biliary drainage as an efficient and safe alternative to surgery to treat AE biliary complications. Insertion of multiple plastic stents delays stent occlusion and leads to effective and prolonged bile duct patency.
Collapse
Affiliation(s)
- Sylvain Ambregna
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Stéphane Koch
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Michael C Sulz
- b Division of Gastroenterology and Hepatology , Kantonsspital , St. Gall , Switzerland
| | | | | | | | - Małgorzata Sulima
- e Institute of Maritime and Tropical Medicine in Gdynia , Medical University of Gdynia , Poland
| | | | - Bertrand Napoléon
- g Gastroenterology department, Mermoz Private Hospital , Générale de Santé , Lyon , France
| | - Armand Abergel
- h Gastroenterology and Hepatology department , University Hospital , Clermont-Ferrand , France
| | - Philippe Bichard
- i Gastroenterology and Hepatology department , University Hospital , Grenoble , France
| | - Isabelle Boytchev
- j Gastroenterology department , Kremlin-Bicêtre University Hospital , Paris , France
| | - Pierre Deprez
- k Gastroenterology department , Saint-Luc University Hospital , Brussels , Belgium
| | - Jerome Dumortier
- l Department of digestive diseases , Edouard Herriot University Hospital , Lyon , France
| | - Jean-Louis Frossard
- m Hepato-Pancreato-Biliary Centre , University Hospital , Geneva , Switzerland
| | - Eric Kull
- n Gastroenterology and Hepatology department , Regional Hospital , Metz , France
| | - Bernard Meny
- o Gastroenterology unit , Clinique Drevon , Dijon , France
| | - Darius Moradpour
- p Gastroenterology and Hepatology department , University Hospital , Lausanne , Switzerland
| | - Fréderic Prat
- q Gastroenterology department , Cochin University Hospital , Paris , France
| | | | - Thierry Thevenot
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Dominique Angèle Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Solange Bresson-Hadni
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| | - Lucine Vuitton
- a WHO Collaborating Centre for the Prevention and Treatment of Human Echinococcosis; Centre National de Référence pour l'Echinococcose alvéolaire; & Department of Gastroenterology, Digestive Endoscopy and Nutrition , University of Franche-Comté and University Hospital , Besançon , France
| |
Collapse
|
28
|
Naseri M, Akbarzadeh A, Spotin A, Akbari NAR, Mahami-Oskouei M, Ahmadpour E. Scolicidal and apoptotic activities of albendazole sulfoxide and albendazole sulfoxide-loaded PLGA-PEG as a novel nanopolymeric particle against Echinococcus granulosus protoscoleces. Parasitol Res 2016; 115:4595-4603. [DOI: 10.1007/s00436-016-5250-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022]
|
29
|
Brunetti E, Praticò L, Neumayr A, Maestri M, Tamarozzi F. Update on Treatment for Cystic Echinococcosis of the Liver. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
30
|
Neumayr A. Radiotherapy of osseous echinococcosis: where is the evidence? Int J Infect Dis 2015; 33:75-8. [PMID: 25582641 DOI: 10.1016/j.ijid.2015.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/05/2015] [Indexed: 12/23/2022] Open
Affiliation(s)
- Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland.
| |
Collapse
|