[Aspects of the surgical treatment in plurivisceral echinococcosis--case report]

Hydatid disease remains endemic in many parts of the world, most notably the Mediterranean region, Australia, New Zealand, the Middle East, and South America. Plurivisceral echinococcosis is defined as the concomitant or successive presence of hydatidosis in more than one internal organ. It has been noticed that the number of cases with multi-organ localizations and multiple cysts has increased in the last years. As the surgery of plurivisceral echinococcosis remains one of the challenges for the medical world, in this article we present our experience during 2000-2007 with this disease, followed by a case report of one of the most special cases of echinococcosis, discussing the principles of treatment, along with a new classification of this disease. Plurivisceral echinococcosis is associated with higher postoperative morbidity and mortality than uncomplicated cysts, related to organ involvement and surgical treatment. In the sequential approach we recommend resolving first surgically the complicated cysts or those at risk. In the thoracic and abdominal locations, the thoracic cysts will be approached first. The treatment methods will be as conservative as possible. Management of pulmonary and hepatic cysts (diaphragmatic side) simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation.

Thoracic hydatid cysts: a report of 842 cases treated over a thirty-year period

From 1957 to 1985, 842 patients were diagnosed as having thoracic hydatid cysts; 810 cysts were intrathoracic, 29 occurred on the "liver roof," 2 were cardiac, and 1 was on the chest wall. A total of 1,010 surgical procedures were performed in 807 patients (35 refused operation). There was a total operative mortality of 0.6% (5 deaths). Procedures became more conservative as experience was gained, and 79% of the procedures were endocystectomies. Intact endocystectomy (Barrett's technique) without preliminary aspiration was the approach of choice. Careful protection of the operating field, suturing of all the bronchial openings, and capitonnage were the keys to successful treatment. One hundred six patients with intact endocystectomies done before July, 1975, were followed for 3 to 20 years. Ruptures occurred during cyst manipulation in 35 patients (33%). Recurrence after operation was seen in 2 patients (1.9%). There were no deaths among the patients undergoing intact endocystectomy. In comparison, we followed 136 patients who underwent aspiration endocystectomy and the recurrence rate was 3.7% (5 patients).

[Clinical classification and surgical treatment of pulmonary echinococcosis in children]

Based upon an analysis of clinical observations of 89 children with echinococcosis of the lungs the author proposes a classification of the disease and touches upon the surgical measures. The main operation was hydatidectomy.

Pulmonary involvement by Echinococcus alveolaris

Twenty cases of pulmonary involvement by E. alveolaris were analyzed and classified into one of two radiological types-Type l: multiple, small, ill-defined, irregular lesions that are peripherally located and develop slowly; and Type II: variable changes of the right lung base. Type 1 has a hematogenous metastatic origin, while Type II is caused by hepatic processes penetrating the hemidiaphragm. Differential diagnosis, which includes neoplasms and infections, specifically E. cysticus, is difficult. Diagnosis appears to be possible only when based on a combination of Type 1 changes, laboratory findings, and geographic occurrence.

[Pulmonary hydatidosis in the child (author's transl)]

In general, pulmonary hydatidosis supposes 22% of the cases treated in a general surgery unity and 4.9% correspond to infantile hydatidosis (98 cases). The authors establish an anatomico-pathological classification of the cyst and make a comparative study with adults. The authors then expound on the different types of complications after the differents treatments used to treat hydatid disease since 1952. Post-operatory morbidity is 4.7% and mortality of 0.9%. These percentages are related to the anatomico-pathological type of the cyst.