Surgical approach of pulmonary hydatidosis in childhood

Outcomes and Risk Factors for Morbidity After Lung Hydatidosis Surgery in Children

OBJECTIVE

To examine outcomes and associated risk factors for children who undergo surgery for lung hydatidosis (LH).

STUDY DESIGN

Through a retrospective and analytical-aim-study, over a period of 35 years in 2 surgical departments, we reported all operative cases for LH in children, regardless of cyst number, location, and aspect. Univariate and multivariable analyses were used to assess variables potentially predictive of postoperative morbidity.

RESULTS

In total, 456 children with a mean age of 10.3 years were included. We performed 544 surgical procedures for 704 cysts with a median size of 60 mm (range 10-200 mm). Thirty-six percent of cysts were complicated. Conservative surgery was performed in 98.5% of cases and anatomical lung resection was required for 1.47% of children. Postoperative complications occurred in 24.4% of children and one death was recorded (0.2%). After multivariable analysis, the independent-associated morbidity risk factors for postoperative morbidity were anatomical lung resection, intensive care unit stay, complicated cyst, a cyst size ≥60 mm, ≥3 bronchial fistulas, associated liver hydatidosis, and the presence or occurrence of empyema during surgery.

CONCLUSIONS

Conservative surgery sparing the lung parenchyma is the treatment of choice for lung hydatidosis and is associated with a low mortality rate. Knowledge of independent risk factors for morbidity may help clinicians to manage children with LH more adequately and improve postoperative outcomes.

Capitonnage Versus Non-Capitonnage in Pediatric Pulmonary Hydatid Disease: A Systematic Review and Meta-Analysis

Background and Aim

Pulmonary hydatid disease, caused by Echinococcus granulosus, presents significant clinical challenges, particularly in pediatric populations. Surgical intervention remains the gold standard for treatment, with various techniques employed, including capitonnage and non-capitonnage methods. This systematic review and meta-analysis evaluates the efficacy and safety of capitonnage compared to non-capitonnage techniques in children.

Methods

This systematic review and meta-analysis followed the PRISMA guidelines to ensure methodological rigor. A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus databases to identify relevant studies. To assess pooled event rates and corresponding 95% confidence intervals for both complications and cure rates, we employed a random-effects model, allowing for variability among study populations. All statistical analyses were conducted using Comprehensive Meta-Analysis software (version 3.7).

Results

Thirteen studies met the established inclusion criteria for analysis. The overall complication rate was 46%, with significantly lower rates in the capitonnage group (24%) compared to the non-capitonnage group (58%). The cure rate was higher in the capitonnage group (83.5%) than in the non-capitonnage group (65.2%). Meta-regression analysis indicated that complication rates were influenced by cyst diameter, study publication date, mean age, and type of surgery.

Conclusion

The findings suggest that capitonnage is associated with better outcomes in terms of lower complication rates and higher cure rates. This evidence supports the use of capitonnage as a preferred surgical technique for managing pulmonary hydatid disease in children. Further research is recommended to explore the long-term outcomes and potential benefits of combining surgical and pharmacological treatments.

Gastrointestinal helminths of stray dogs in Erzurum province: prevalence and risk to public health

Dogs have an important role in public health due to their close contact with humans and living in common areas. This study was aimed to investigate the presence and prevalence of gastrointestinal system helminths in stray dogs in Erzurum province. Gastrointestinal helminth eggs were detected in a total of 190 out of 446 (42.6%) in stray dogs in Erzurum province. In the study, taeniid eggs (17.71%, 79/446), T. canis (16.82%, 75/446), T. leonina (12.78%, 57/446), Linguatula spp. (4.48%, 20/446), spiny-headed worms (2.91%, 13/446), hookworms (2.69%, 12/446), Alaria spp. (1.12%, 5/446) and Trichuris spp. (0.22%, 1/446) eggs were observed. In addition, proglottid structures of Mesocestoides spp. (3.14%), Taenia spp. (2.69%), and D. caninum (1.12%), adults of Alaria spp. (0.22%), T. canis (0.22%), and T. leonina (0.22%) were detected. According to the results of the study, zoonotic parasites including taeniid cestodes, T. canis, Linguatula spp., spiny-headed worm, hookworm, Alaria spp., and Trichuris spp. were common in stray dogs in the province. Public health risks can be reduced by regular deworming of dogs, proper management of the process, prevention of environmental contamination with dog feces, and proper enforcement of sanitation protocols.

Primary Disseminated Hydatid Disease Involving Multiple Organs in a Pediatric Patient: A Rare Case Report

Hydatid disease is a parasitic infestation by Echinococcus genus of tapeworm, resulting from ingestion of tapeworm eggs and leading to formation of cysts predominantly in the liver and lungs. Multiorgan involvement in children is unusual. We present a case of a 12-year-old female with multiple organ involvement. Patient had history of abdominal pain, breathlessness, irritability and vomiting. Plain radiograph showed a large ovoid calcific lesion projected over the liver. Abdominal sonography demonstrated multiple hydatid cysts in the liver, spleen and left kidney. Ultrasound findings were further confirmed by contrast-enhanced computed tomography that showed additional hydatid cysts in bilateral lungs. All accessible cysts were excised on laparotomy. Cystic hydatid disease should be suspected in all pediatric patients with multiple cystic lesions, especially in endemic areas.

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.

The diagnostic value of fiberoptic bronchoscopy in ruptured lung hydatid cysts

BACKGROUND

This study aims to evaluate the diagnostic yield of fiberoptic bronchoscopy in ruptured pulmonary hydatid cysts indistinguishable from pulmonary masses on imaging techniques.

METHODS

Between January 2000 and January 2018, a total of 45 consecutive patients (27 males, 18 females; mean age 46.4±13.5 years; range, 23 to 78 years) who underwent fiberoptic bronchoscopy to establish the definitive diagnosis following radio-diagnostic procedures were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, preoperative diagnostic studies, bronchoscopic findings, and postoperative diagnosis were recorded.

RESULTS

Endobronchial hyperemia (n=42) and purulent secretion (n=34) are the most common findings of bronchoscopy. The most specific finding was the presence of pieces of cystic membranes in 23 patients. Scolices were seen in five patients in bronchial aspirate. In one patient, both pieces of cystic membranes and scolices in bronchial aspirate were detected. The preliminary diagnosis of a hydatid cyst was made based on these findings in 28 patients (62.2%) preoperatively. The definitive diagnosis of a hydatid cyst was confirmed through thoracotomy in all patients.

CONCLUSION

Bronchoscopy is a particularly valuable method in the definitive diagnosis of ruptured lung hydatid cysts. The definite diagnosis is based on the visualization of the endobronchial membrane during bronchoscopy or scolices in the bronchial aspirate. It can be also used to prevent complications such as bronchial dissemination and asphyxia due to intra-bronchial membrane pieces.

[Combined echinococcosis management in children]

AIM

To analyze the results of diagnosis and treatment of combined echinococcosis.

MATERIAL AND METHODS

The study included 51 children. 40 (78.4%) of them had combined lesion of liver and other organs, 29 - combined echinococcosis of liver and lungs. Echinococcosis of both lungs was observed in 14 children including lesion of liver in 6 cases. Combined echinococcosis of three organs was observed in 5 patients.

RESULTS AND DISCUSSION

Combined echinococcosis in children was associated with uneven growth of parasitic cysts in various tissues. Small cysts were revealed in 15 (37.5%) out of 40 observations of combined lesion of liver and other organs. 7 patients underwent medical therapy for small cysts after previous surgery for medium and large cysts. Rapid growth of remained cysts occurred within 1-3 months between surgical stages. It may be often associated with complications related to remained cyst especially in case of both lungs echinococcosis. There were 6 (11.8%) postoperative complications in 51 patients with combined echinococcosis. Recurrence occurred in 2 (3.9%) children. Deaths were absent.

CONCLUSION

Conservative therapy for small cysts provides 2-fold decrease of operations number and prevents recurrence of the disease. Reduced period between surgical stages up to 11±2 days prevents complications in case of both lungs echinococcosis.

Pre-school children with hydatid lung disease

BACKGROUND

Hydatid cyst disease is a major health problem in developing countries and it usually settles in the lungs in children. This study aimed to present pre-school children with lung hydatid cysts cases that underwent surgical treatment.

METHODS

The authors retrospectively investigated 42 consecutive pre-school patients who were diagnosed and surgical treated for hydatid cysts in their clinic between January 1998 and December 2011.

RESULTS

Seventeen (40.5%) patients were female and 25 (59.5%) patients were male. The average age of the patients was 5.2 +/- 1.3 (between 2-7 years). The most common symptoms were cough (74%), chest pain (26.2%), and fever (26.2%). Twenty-eight cases had cysts in only one lung; in five cases, the cysts were in a single lung and the liver, in six cases, in bilateral lungs and liver, and in three cases, in bilateral lungs. The average cyst diameter was 6.2 +/- 2.4 (2-12) cm. In five cases, there were combined interventions to the right lung and liver cysts with a transdiaphragmatic approach. Nine patients with bilateral hydatid cysts underwent operations. Muscle protector thoracotomies were performed in eight cases. Cystotomy and capitonnage were applied to all lung cysts. One patient underwent a bronchoscopy for postoperative atelectasis. In one case, postoperative fever was observed. There was no postoperative mortality. Postoperative average hospital stay was 7.2 +/- 2.1 (3-13) days.

CONCLUSION

Surgery is the definitive treatment for lung hydatid cysts. The most important way to protect against the adverse effects of a thoracotomy is to eliminate the routes of transmission.

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.

Parasitic lung infection and the paediatric lung

Human parasitosis is still prevalent worldwide and causes significant morbidity and mortality in developing countries. The involvement of the lung is variable depending on the characteristics of the parasites and hosts. In malnourished and immunodeficient children, the consequences of lung parasitosis may result in significant morbidity and mortality.

[Surgical treatment of pulmonary hydatid cysts in childhood]

OBJECTIVES

To analyse the radioclinical forms of pulmonary hydatid cyst in children, and to evaluate the results of surgical treatment.

PATIENTS AND METHODS

During a period of 4 years (2002-2005), 26 surgical procedures were performed for pulmonary hydatid cyst in 23 children (16 boys and 7 girls, mean age 13, 5 years). Symptoms were chest pain (87%), broncho-pulmonary infection (32%) and hemoptysis (22%). Chest x-ray showed a non-complicated cyst in 62% of cases. The CT scan was performed in 15 cases (65%), mainly for complicated forms. Abdominal echography for all patients showed 3 hepatic localisations of hydatid cyst. All the patients underwent surgical treatment by thoracotomy.

RESULTS

In a total of 34 cysts, 21 were uncomplicated, 13 complicated (intra-bronchial rupture: 11 cases, pleural rupture: 2 cases). Cystectomy or pericystectomy were performed in 91% of cases, segmentectomy in 6% and a lobectomy in 3%. Decortication was done in the 2 pleural-ruptured cases. There was no mortality. One lower left lobe atelectasis was observed post-operatively.

CONCLUSION

Conservative surgical techniques for pulmonary hydatid cysts in children are preferred to parenchyma resection. In our practice the treatment of bilateral hydatidosis in 2 times decreases the complication rate.

Effect of capitonnage and cystotomy on outcome of childhood pulmonary hydatid cysts

OBJECTIVE

In this clinical retrospective study cystotomy and capitonnage were compared in patients with childhood pulmonary hydatid cysts with regard to postoperative period.

METHODS

Between 1990 and 2004, 60 children with pulmonary hydatid cysts were treated surgically. There were 33 boys and 27 girls aged from 3 to 16 years. Cystotomy and closure of bronchial openings were performed in all patients. The patients were divided into 2 groups. While the residual cyst cavity was closed by means of capitonnage in group A (n = 37), cystotomy was applied in group B (n = 23).

RESULTS

There was no mortality in either group. Chest tubes were removed after 3.59 +/- 1.04 days in group A and 5.83 +/- 2.84 days in group B. The hospital stay was 4.86 +/- 1.43 days for group A and 7.22 +/- 3.34 days for group B. Prolonged air leak was found in 2 children in group A and 7 children in group B. There was a significant difference between group A and group B with regard to chest tube removal time (P = .001), hospital stay (P = .003), development of prolonged air leak (P = .004), and all complications (P = .031). Follow-up information was available for 49 children, ranging from 13 to 86 months (mean, 56 months). Recurrence was seen in 2 children of group A and 1 child of group B during the follow-up period (P = .698).

CONCLUSION

Capitonnage for pulmonary hydatid cysts is superior to cystotomy because it reduces morbidity (especially prolonged air leak) and hospital stay.