[Pelvic hydatid cyst: differential diagnosis with a bacterial abscess with cutaneous fistula]

Parietal complication of the hydatid disease: Comprehensive literature review

BACKGROUND

The aim of the study was to provide an overview of the medical literature on parietal complications of hydatid disease (HD).

METHODS

A literature search was conducted on PubMed, Medline, Google Scholar, and Google databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using keywords to identify articles related to parietal complications of HD in the thoracic and abdominal cavities. The following keywords were used: HD, hydatid cyst, cystic echinococcosis, alveolar echinococcosis, abdominal HD, thoracic HD, parietal complication, cutaneous fistulization, cystocutaneous fistulization, cutaneous involvement, external rupture, external fistulization, subcutaneous involvement, and subcutaneous abscess. The language of publication, journal, or country was not included as limitation criteria, and publications dated before August 1, 2016, were considered. Articles or abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management were included in the study, whereas articles with insufficient clinical and demographic data were excluded.

RESULTS

The literature review included 52 articles involving 55 patients with parietal complications of HD. Thirty-two articles were written in English, 15 in French, 2 in Spanish, 1 in Italian, 1 in German and 1 in Russian. All 55 patients (women, 30; men, 23; unknown, 2) involved in the study were aged 7 to 93 (mean ± standard deviation, 54.5 ± 20.2) years. A total of 24 patients had cysto-cutaneous fistula (Echinococcus granulosus), 12 had subcutaneous rupture, 10 had cutaneous fistula (E multilocularis), 3 had cystosubcutaneous abscess, 3 had cysto-cutaneo-bronchial fistula, 2 had cysto-cutaneo-bronchio-biliary fistula, and 1 had cutaneo-bronchial fistula. E granulosus were detected in 43 and E multilocularis in 12 patients through clinical, radiological, or histopathological examinations.

CONCLUSION

Parietal complications such as cysto-cutaneous fistulization are a rare complication of HD. Complicated HD should be considered in the differential diagnosis of patients presenting with cutaneous involvement, especially in HD endemic regions.

The Case of Reactive Arthritis Secondary to Echinococcus Infestation

Reactive arthritis is an inflammatory joint disease that develops after an infection and it usually occurs following a gastrointestinal or genitourinary system infection and it belongs to the family of arthritis called “spondyloarthritis.” We wanted to represent a rare case of reactive arthritis secondary to Echinococcus infestation. Cyst hydatid disease is common in endemic regions like Turkey. Internal organ involvements, especially liver and lung, are most frequent involvements. Primary bone involvement is rare complication of Echinococcus infestation. In our case, the patient with Echinococcus infection developed right knee arthritis and sacroiliitis. Other reactive and oligoarthritis causes were excluded and diagnosis of reactive arthritis secondary to cyst hydatid infestation was done with the present findings. Cold pack and TENS treatment were applied as symptomatic treatment to the right knee of the patient. Acemetacin was given as medical treatment. On the 5th day of treatment, right knee and ankle arthritis were clinically regressed. In regions where the disease is seen as endemic, such as Turkey, patients with musculoskeletal symptoms should consider the possibility of musculoskeletal involvement due to the hydatid cyst.

Cutaneous fistulization of the hydatid disease: A PRISMA-compliant systematic review

AIM

To provide an overview of the medical literature on cutaneous fistulization in patients with hydatid disease (HD).

METHODS

According to PRISMA guidelines a literature search was made in PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to cutaneous fistulization of the HD. Keywords used were hydatid disease, hydatid cyst, cutaneous fistulization, cysto-cutaneous fistulization, external rupture, and external fistulization. The literature search included case reports, review articles, original articles, and meeting presentations published until July 2016 without restrictions on language, journal, or country. Articles and abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management, were included in the study, whereas articles with insufficient clinical and demographic data were excluded. We also present a new case of cysto-cutaneous fistulization of a liver hydatid cyst.

RESULTS

The literature review included 38 articles (32 full text, 2 abstracts, and 4 unavailable) on cutaneous fistulization in patients with HD. Among the 38 articles included in the study, 22 were written in English, 13 in French, 1 in German, 1 in Italian, and 1 in Spanish. Forty patients (21 males and 19 females; mean age ± standard deviation, 54.0 ± 21.5 years; range, 7-93 years) were involved in the study. Twenty-four patients had cysto-cutaneous fistulization (Echinococcus granulosus); 10 had cutaneous fistulization (E multilocularis), 3 had cysto-cutaneo-bronchio-biliary fistulization, 2 had cysto-cutaneo-bronchial fistulization; and 1 had cutaneo-bronchial fistulization (E multilocularis). Twenty-nine patients were diagnosed with E granulosis and 11 had E multilocularis detected by clinical, radiological, and/or histopathological examinations.

CONCLUSION

Cutaneous fistulization is a rare complication of HD. Complicated HD should be considered in the differential diagnosis of cases presenting with cutaneous fistulization, particularly in regions where HD is endemic.

Echinococcus multilocularis infection of the liver presenting as abdominal wall fistula

Echinococcus multilocularis causes infection where the most commonly affected organ is the liver, followed by the lung, kidney, bone and the brain. Other sites such as the heart, spleen, pancreas and soft tissues are very rarely affected. Surgical treatment combined with chemotherapy using various technical approaches remains the main therapeutic modality for echinococcal liver disease. To the best of our knowledge there are less than five clinical cases of cutaneous presentation of liver alveolar echinococcosis described. We present a unique case of liver echinococcosis presenting as recurrent abdominal wall fistula and abscess in a 29-year-old man. Diagnosis was based on CT imaging, serological analysis and histological findings from the fistula. Medical treatment with albendazole was initiated and liver resection was performed. The patient has no symptoms and signs of recurrence 1 year after operation, while still on albendazole therapy. This case description highlights the importance of early suspicion and treatment of unusual echinococcosis clinical presentations.

Extra-hepatic intra-abdominal hydatid cyst: which characteristic, compared to the hepatic location?

Hydatid cysts are mostly located in the liver, followed by the lung. Primary and isolated extrahepatic intra-abdominal hydatid cysts (PIEHC) are rare and only a few sporadic series have been reported. This article aims to study the epidemiological, diagnostic difficulties and therapeutic principles of PIEHC. More over, it aims to make comparison between PIEHC and the liver location of the cyst concerning all these data. We report a retrospective study from January 1995 to September 2010 concerning 34 patients who underwent surgical removal of a PIEHC. The mean age was 46 years. Abdominal pain was the main symptom, and was found in 27 patients (79.4 %). Physical examination revealed an abdominal mass in 19 patients (55.9 %). In 6 patients (17.6 %) the PIEHC was incidental. Abdominal ultrasound and abdominal CT scan helped to highlight all cystic masses. The diagnosis was established preoperatively in 28 patients (84.8 %). Five patients (14.7 %) were operated with a diagnosis other than PIEHC. The diagnosis was made intraoperatively in one case (2.9 %). A laparotomy in 24 cases (70 %) was the surgical approach often used. Majority of the patients, 25 cases (73.5 %), received a conservative procedure. Only 3 patients (8.8 %) had recurrences and were reoperated. The diagnosis of PIEHC is often facilitated by means of modern imaging, however, serious diagnostic problem were found with a pancreatic location of the cyst. Complete surgical excision, when possible without major sacrifice, seems to be the best therapeutic option to reduce the risk of recurrence.