Intra-biliary hydatid cyst rupture: A rare case report with superinfection

Key Clinical Message

Hydatid cysts, primarily found in the liver (70%), are caused by parasitic infections and can lead to severe complications such as cyst rupture. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.

Abstract

Hydatid cysts are a clinical pathology resulting from parasitic infections. They may occur in different organs of the body. However, these are mostly found in the liver (70%). This can cause significant complications including cyst rupture. Several case reports have described various hydatid cyst ruptures; however, only a few have reported an intra-biliary hydatid cyst rupture. A 24-year-old male patient presented with right upper quadrant pain, jaundice, dark urine, and pale stool. Imaging studies, including Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), revealed a beavertail liver, cystobiliary communication and intrahepatic biliary tree-ruptured hydatid cysts. The cyst was in the right liver lobe, which is the most common site for hydatid cysts. Surgical intervention involving laparoscopic de-roofing and cyst removal resulted in a smooth recovery without complications. Several case reports have described various hydatid cyst ruptures; however, only a few have reported originally placed intra-biliary hydatid cyst ruptures. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.

Anaphylaxis during puncture of a hepatic hydatid cyst

Although hydatid cyst infects many organs, it most commonly involves liver, lungs, and central nervous system. The goal of hydatid cyst treatment is to completely eliminate the parasite and to prevent recurrences with minimal mortality and morbidity. The procedure of puncture, aspiration, injection of a scolicidal, and reaspiration (PAIR) of a cyst has been introduced as an alternative to surgical method since it is less invasive and less morbid and is associated with a shorter hospital stay and a lower cost. Herein, we report an 11-year-old girl who developed anaphylaxis during the puncture of a hepatic hydatid cyst. The patient who developed anaphylaxis during the PAIR procedure was administered intravenous adrenaline, methyl prednisolone, and antihistaminic medication. She was intubated and provided assisted ventilation using a mechanic ventilator. The child was extubated 4 h after her admission to the pediatric intensive care unit. During follow-up, the contents of her hepatic hydatid cysts were aspirated through a catheter, followed by their irrigation with 20% sodium chloride and re-aspiration. Then, 97% ethyl alcohol was injected into the cyst cavity to make it collapse. The goal of this report was to draw attention to the rare occurrence of anaphylaxis during the PAIR procedure and to stress that clini-cians should be vigilant for this complication.

Treatment of hydatid cyst with albendazole desensitization: A pediatric case report

Albendazole is a benzimidazole group drug used alone or in combination with surgery in the treatment of many helminthiasis, especially hydatid cysts. Type 1 hypersensitivity reaction has been reported rarely. Treatment with desensitization has been successfully applied in a few adult patients, however literature information on pediatric patients was not available. Here, we present a pediatric case in which Type 1 reaction occurred due to the use of albendazole during hydatid cyst treatment and undergone desensitization.

Large Gluteal Cystic Lesion in a Child: A Challenging Diagnosis of a Hydatid Cyst

Early identification of asymptomatic hydatid cysts, produced by Echinococcus parasites in their larval form, is crucial due to their frequent late-stage diagnosis. Radiological imaging plays a significant role in early detection. These cysts mostly impact the liver and lungs but may manifest in other areas of the body, presenting distinct diagnostic difficulties. This case example emphasizes the need for using radiological imaging and maintaining a high level of suspicion when it comes to identifying hydatid cysts in young patients. We present an exceptional case of a three-year-old child in good health who developed a painless gluteal enlargement that resulted in constipation. An abdominal CT scan detected a hydatid cyst located posterior to the bladder, along with an accompanying hepatic cyst. The diagnosis was confirmed by a positive Weinberg test, and the treatment consisted of a 28-day course of albendazole. The key takeaway from this case report is that prompt diagnosis and radiological imaging play a critical role in instances of hydatid cysts.

Effectiveness Evaluation of Viti's vinifera Leaf Extract on the Viability of Echinococcus Eggs and Protoscolices In Vitro

Echinococcosis is a zoonotic disease caused by the genus Echinococcus. Globally, it is one of the most central helminthic diseases. Surgery remains the method of choice to remove cystic Echinococcus. Various sporicidal agents have been used to invalidate the substances in hydatid cysts. Nevertheless, many sporicidal agents cause inflammation and can cause side complications, so their use should be limited. The study aims to evaluate the effectiveness of Vitis vinifera leaf methanolic extract as a sporicidal agent for Echinococcus eggs and protoscolices and determines the best concentration. The mortality and viability of protoscolices were measured in samples exposed to four concentrations of V. vinifera leaf extract (VVLE) (5, 10, 30, and 50 mg/mL) for 5, 10, 20, and 30 min and in eggs exposed to three concentrations (100, 200, and 300 mg/mL) for 24 and 48 h. An infrared spectroscopy chemical test was conducted to assess the presence of numerous expected active components in the extract. The viability of eggs and protoscolices was confirmed using 0.1% eosin staining. Vinifera leaf extract exhibited the decisive sporicidal effect at 100%, 91%, 60%, and 41% after 30 min at concentrations of 50, 30, 10, and 5 mg/mL, and in eggs at 11% and 19% after 24 and 48 h at a concentration of 200 mg/mL, respectively. Increased incubation times and higher dosages often increase mortality. The results exhibited that V. vinifera is effective. This study confirmed that grape leaf extract has high sporicidal activity in vitro. However, more studies are required to determine the exact active chemical and its action mechanism and perform in vivo utilization to confirm these results.

Health and economic burden of pathological lesions in livers and lungs of slaughtered sheep at Mosul Abattoir, Iraq

Background

Slaughterhouses can provide valuable information about animal diseases and their epidemiology.

Objectives

The current study was designed to examine the health and economic burden of pathological lesions in livers and lungs of slaughtered sheep at Mosul abattoir, Iraq.

Methods

Mosul abattoir records for sheep slaughtered between 2011 and 2013 were considered for inclusion in this study. The direct financial loss due to liver and lung lesions was estimated considering the average number of slaughtered sheep per year, the average percentage of liver lesions per year, and the average percentage of lung lesions per year. Monetary values of the liver and lung were obtained from local butcheries.

Results

The analysis indicated that the percentage of lesions observed in the liver and lung per year was 6.9% and 5.8%, respectively. Hydatid cyst followed by hepatitis was the most frequent lesions identified in the liver, while pneumonia then hydatid cyst were detected in the lung, followed by worms, abscess, and miscellaneous lesions. Hydatid cyst was the most frequently observed lesions. The average total loss was 35,232 USD per year (mostly due to liver lesions), with ±7046 USD sensitivity to the price change.

Conclusions

The percentage of lesions observed in the liver and lung per year is not negligible and can cause considerable economic losses.

Detection of Anti-Echinococcus granulosus Antibodies in Humans: An Update from Pakistan

Human cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of Echinococcus granulosus sensu lato that causes economic losses by affecting livestock and also poses a public health threat worldwide. The present study is the first retrospective report on the seroprevalence of anti-E. granulosus antibodies in humans in Pakistan. The study used data from 93 blood analysis reports of patients suspected of having CE from different medical centers in Lahore, Pakistan. Out of 93 sera samples, 20 (21.5%) were seropositive, and higher seropositivity (17.2%) was recorded with the indirect hemagglutination test (IHA) than with enzyme-linked immunosorbent assay (ELISA). The findings indicated that age, gender, and year had no significant relationship with the seropositivity of CE. The current study provides directions towards the management of the disease in the near future in Pakistan.

Hydatid Cysts of Parotid Glands- Diagnosis, Treatment and Recurrences

Hydatidosis (Echinococcosis) is a disease caused by infestation of hydatid cysts in any organ of body but mainly liver (70% of cases). Hydatidosis of salivary glands is rare and necessitate computerized tomography for diagnosis while fine needle aspiration remains controversial procedure.

Single-Stage Transthoracic Surgery of Right Pulmonary and Hepatic Hydatid Cysts: A Retrospective Study of Fourteen Patients

Background: The association of pulmonary and hepatic hydatid cysts is rare. Managing this condition with low mortality and complications is a challenge. The aim of this study is to put forward our experience in managing both sites in single-stage posterolateral thoracotomy. Patients and Methods: A retrospective study of 14 patients who underwent single-stage posterolateral thoracotomy and phrenotomy to treat right lung and liver hydatid cysts between January 2010 and December 2019 were reviewed. Results: Fourteen of 135 patients (10.4%) with double location of hydatid disease were treated in our department for pulmonary hydatid cysts in the same period. There were nine males and five females who were 20 to 72 years old (average age, 42.7 years). Chest computed tomography (CT) and abdominal scan were performed in all cases. The surgical approach was posterolateral thoracotomy and phrenotomy without laparotomy in all cases. Conservation of hepatic and pulmonary parenchymas was possible in 13 patients (92.8%). Average operative time was 122 minutes (range, 95-210 minutes) and the average post-operative hospital stay was 8.7 days. Post-operative complications occurred in two (14.3%) cases, one was atelectasis and the other persistent biliary and air leakage. There was no post-operative mortality. All patients received post-operative medical treatment for three to six months and there was no recurrence after an average follow-up of 26 months. Conclusion: Single-stage thoracotomy is a better option than thoracotomy and laparotomy for the management of double located hydatid cysts. It has a lower complication rate, shorter hospital stay, and rapid resumption of normal activity.

Unusual localizations of hydatid cysts: a rare case report from Syria

Hydatid disease (HD) is an infection with the metacestode stage of the tapeworm Echinococcus. It is commonly seen in South America, The Middle East, Eastern Mediterranean, Africa and China. Hydatid cysts usually affect the liver followed by the lungs. Involvement in other organs has been reported. However, in the majority of the cases, cysts are localized in one organ or one region. We report a rare case of a 36-year-old woman who presented to the hospital in Syria with long-standing history of non-specific abdominal pain. Computerized tomography showed several hydatid cysts in the liver, spleen, left lung, mediastinum (adjacent to the aortic arch), both breasts and above the right gluteal muscles.

Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts

AIM

To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs).

MATERIALS AND METHODS

Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively.

RESULTS

Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6-24) months, and the mean age was 39.4 (range, 24-56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration-injection-reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment.

CONCLUSION

There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

Hydatid cyst of the thyroid gland with tracheal fistula: A case report and review of the literature

Hydatid disease, also known as echinococcal disease, is a zoonotic disease caused by Echinococcus infection. Hydatid cysts of the thyroid are rare. The present case study reports on a patient with hydatid cyst in the thyroid with tracheal fistula. A 54-year-old male patient without any history of exposure to farm animals was hospitalized due to fever and productive cough with occasional hydatid daughter cyst. The patient was diagnosed with a hydatid cyst of the thyroid gland with tracheal fistula by relevant examination. An operation was performed to remove the hydatid cyst and to repair the fistula. The patient took oral albendazole after surgery to prevent hydatid recurrence. Operative recovery was uneventful and the patient resumed his normal activities. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome. Furthermore, the characteristics of thyroid cystic echinococcosis, and its diagnosis and treatment in the present case and other cases reported in the literature were summarized and reviewed. Although the thyroid gland is rarely affected, hydatid cyst disease should be considered as a differential diagnosis of cystic lesions of the thyroid gland in patients living in regions where hydatid cyst disease is endemic.

Protoscolicidal effect of oleuropein: an in vitro study

OBJECTIVES

Hydatid disease is a parasitic disease caused by Echinococcus granulosus and is still endemic in many parts of the world. Scolicidal solutions are generally used in any type of intervention, either surgical or percutaneous, to neutralize the cyst contents, although completeness of their effect is obscure and solid evidence is scarce. On the other hand, the use of these scolicidal solutions is not devoid of complications and many serious complications such as caustic sclerosing cholangitis may be seen in relation with their usage. Recent investigations proved protoscolicidal properties of olive leaf extract although the active ingredient has not been attributed to any component. The aim of this experimental study was to isolate oleuropein and test for in vitro protoscolicidal activity.

MATERIAL AND METHODS

Oleuropein, a phenolic compound found in olive leaves, is extracted and prepared in different concentrations. Echinococcal cyst containing livers of sheep are obtained from the government slaughterhouse. Cysts were punctured and live protoscolex suspensions were prepared under aseptic conditions. Different concentrations of oleuropein solutions were prepared and protoscolicidal property is analyzed and compared with positive and negative controls for different exposure times.

RESULTS

Oleuropein 2% concentration was found to be protoscolicidal in all exposure times starting from 5 minutes.

CONCLUSION

2% oleuropein is a powerful, natural protoscolicidal agent which should be evaluated clinically before its application in routine treatment practice.

Primary Giant Cerebral Hydatid Cyst in an 8-year-old Girl

Echinococcosis, also called hydatid disease, is a parasitic disease that passes from animals to humans. Literature reports suggest very rare cases of cerebral hydatid cysts. Brain involvement with hydatid disease occurs in 1%–2% of all Echinococcus infections. In this report, we aim to emphasize the presentation of such an isolated primary cerebral hydatid cyst, discuss its radiological features, Emergency department management, inpatient medical management, referral to neurosurgery, consequent operative procedures, postoperative care, and outcome.

An unusual cause of chest pain: An isolated huge cardiac hydatid cyst

Hydatid disease is a human parasitic infection caused by the larval stage of Echinococcus granulosus. The most common locations for hydatid cysts are the liver and lungs. Cardiac involvement is rare, and isolated cardiac hydatid cysts are even more unusual. We report the case a 48-year-old female patient with an isolated huge cardiac hydatid cyst involving both the left ventricular free wall and the pericardium, and presenting with atypical chest pain. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:262-264, 2018.

The study of biochemical profile of cyst fluid and diffusion-weighted magnetic resonance imaging in differentiating hepatic hydatid cysts from liver simple cysts

Purpose

The aim of this study was to investigate the value of biochemical profile of cyst fluid and diffusion‐weighted imaging (DWI) in differentiating hepatic hydatid cysts (HCs) from liver simple cysts.

Materials and methods

Forty‐six patients underwent MR imaging. Twenty‐nine patients had 29 hydatid cysts and 17 patients had liver simple cysts. Thirteen patients with hydatid cysts and seven patients with liver simple cysts were evaluated with cyst fluid biochemical analysis. The concentration of glucose, protein, calcium ion (Ca²⁺) electrolyte, macroscopic appearance, and parasitological sediment were evaluated in this study.

Results

In the respect of biochemical analysis cyst fluid, the concentration of glucose and calcium ion of HCs was significantly higher than that of the liver simple cysts. In the respect of DWI, in the b 1000 s/mm² value in respect of mean application data center (ADC) values, there was a statistically significant difference between HCs group (the mean value was (2.50±0.79)×10⁻³ mm/s²) and liver simple cysts group (the mean value was (2.92±0.66)×10⁻³ mm/s²). However, no statistically significant results were obtained in the ADC measurements of b 500 s/mm² between two groups.

Conclusion

The analysis of cyst fluid combined with the measurement of ADC values in the b 1000 s/mm² value could be considered a promising parameter as an alternative to the differential diagnosis of hepatic hydatid cysts from liver simple cysts.

Multiple cerebral hydatid cysts in 8-year-old boy: A case report and literature review of a rare presentation

Background:

Multiple cerebral hydatid cysts are very rare with only a few reports in the literature detailing diagnostic workup, medical management, surgical techniques, possible complications, and outcomes.

Case Description:

We present the case of an 8-year-old boy who presented with progressively worsening headaches, vomiting, and intermittent fever since 20 days. Diagnostic workup was performed, and magnetic resonance imaging revealed multiple intracranial cysts predominantly in the right frontal region with significant mass effect. A total of 19 intracranial cysts were removed surgically, and the child recovered uneventfully.

Conclusions:

Neurosurgeons should keep hydatidosis in the list of differentials when evaluating patients with cystic diseases of the brain. Although the removal of such cysts is challenging, outcomes are excellent when cysts are evacuated without rupture and patients show complete resolution of symptoms.

Surgical management of cystic lesions in the liver

BACKGROUND

Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear.

METHODS

A Pubmed and Medline literature review using key words non-parasitic hepatic cysts, polycystic liver disease, echinococcus, hydatid cysts parasitic cysts, Caroli's disease, cystadenoma; liver abscess, surgery, aspiration and treatment was undertaken and papers pertaining to the diagnosis and management of cystic lesions within the liver were retrieved.

RESULTS

Asymptomatic simple cysts in the liver require no treatment. Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. At present, insufficient evidence exists to recommend one over the other. Polycystic liver disease presents a unique management problem because of high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can effectively be treated by aspiration or drainage. With improved antimicrobial efficacy, prolonged treatment with antibiotics may also be considered.

CONCLUSION

All patients with cystic lesions in the liver require discussion at multi-disciplinary meetings to confirm and the diagnosis and determine the most appropriate method of treatment.

Controversies in the laparoscopic treatment of hepatic hydatid disease

BACKGROUND

Laparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients.

METHODS

Six hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreatobiliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi.

RESULTS

Conversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (11.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and 11 years.

DISCUSSION

Laparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations.