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

The recurrence rate after primary resection cystic echinococcosis: A meta-analysis and systematic literature review

Cystic echinococcosis (CE) is a chronic, complex, zoonotic disease caused by Echinococcus Granulose tapeworms. The disease may present with a variety of symptoms, ranging from asymptomatic to fatal. Surgical intervention is the primary treatment modality for CE. Despite advances in surgical techniques and chemotherapy, disease recurrence remains a major concern. Therefore, we aimed to determine the true rate of CE recurrence after primary resection and identify possible factors that increase the risk of recurrence. A systematic search of Medline, PubMed, Embase, and Cochran Library was conducted to identify studies reporting the incidence of CE recurrence after primary radical surgery. Data were pooled using random effect models. The disease prevalence was determined by calculating the ratio of CE recurrence and the total number of patients. A meta-regression was conducted to identify any potential factors linked to recurrence. A total of 38 eligible studies, with a total of 6,222 CE patients who underwent primary surgical removal, revealed a pooled recurrence rate of 8% (95% CI: 6%-10%). However, significant heterogeneity was observed (I2 p-value <0.001). Subgroup analysis by region showed the highest incidence of recurrence in European and Turkish studies, with rates of 11% (95% CI: 7%-17%) and 9% (95% CI: 5%-14%), respectively. The lowest recurrence rate was observed in Asian studies, with a rate of 4% (95% CI: 2%-7%). Moreover, the non-radical intervention has a recurrence of 5% (95%CI: 4%-7%), radical 7% (95%CI: 6%-9%), and studies that contained both interventions have 10% (95%CI: 6%-16%), P-value= 0.04. This is the first meta-analysis to evaluate the overall incidence of CE recurrence after primary surgical removal. The study also revealed a substantial degree of heterogeneity across the included studies and indicated possible risk factors for higher recurrence rates, such as the study's geographic area, type of surgery and the year it was published. These findings will help to guide future research in developing effective strategies to prevent or reduce CE recurrence and improve patient outcomes.

Extrahepatic intraabdominal hydatid cyst: a case report

BACKGROUND

Hydatid disease, also known as echinococcosis, is a zoonotic parasitic infection caused by the larvae of the Echinococcus tapeworm. It is endemic in various regions worldwide, particularly in rural areas of countries in southern South America, Central Asia, China, parts of Africa, the Mediterranean, and parts of the Middle East. The disease primarily affects the liver (60-70% of cases) and the lungs (10-25% of cases), but it can involve any organ, including the brain, bones, and rarely the pelvic region, as seen in our case report. Hydatid disease typically follows an asymptomatic course in the early stages of the primary infection and may remain so potentially for years or even permanently. If symptoms occur, they depend on various factors, such as the number, size, and location among other factors. Typically, hydatid disease presents with nonspecific symptoms. Common symptoms include abdominal pain, hepatomegaly, as well as anaphylaxis in case of cyst rupture. Extrahepatic intra-abdominal isolated hydatic cyst is a rare finding (6-11%).

CASE PRESENTATION

In our case, a 70 year-old Asian white male presented with right thigh pain radiating to the lower leg, which is an atypical presentation for an extrahepatic intraabdominal hydatid cyst. Primary intraabdominal hydatid cysts involving the pelvic region are relatively rare, and such cases pose diagnostic and management challenges.

CONCLUSION

This case report underscores the challenges in diagnosing and managing extrahepatic intraabdominal hydatid cysts, particularly in atypical presentations. A combination of clinical evaluation, serological studies, and imaging techniques facilitates accurate diagnosis.

Primary giant hydatid cyst of the retroperitoneum: Diagnosis and therapeutic approaches

INTRODUCTION AND IMPORTANCE

Primary hydatid cyst of the retroperitoneum is an exceedingly rare manifestation of hydatid disease. Diagnosis proves challenging due to nonspecific symptoms, and the condition is typically not suspected when facing a retroperitoneal cystic mass, necessitating awareness among clinicians and surgeons, particularly in endemic regions.

CASE PRESENTATION

A 45-year-old male with a three-month history of progressive abdominal enlargement and pain. Living in a rural area, he exhibited a 30 cm, well-defined retroperitoneal cyst, with no guarding confirmed by CT-scan, with characteristic daughter cysts. The diagnosis of primary retroperitoneal hydatid cyst was supported by positive hydatid serology and eosinophilia. Surgical intervention was crucial, and a complete pericystectomy, with 4 cm of pericyst on the aorta due to safety concerns, was performed after three months of preoperative albendazole-based treatment. The postoperative course was uneventful, and a two-year follow-up revealed no recurrence.

CLINICAL DISCUSSION

The prevalence of hydatid disease in North Africa is high, yet retroperitoneal cases are rare. The difficulty to diagnosis retroperitoneal masses, underscores the importance of precise patient evaluation and detailed imaging analysis. Percutaneous puncture is contraindicated due to the risk of dissemination, highlighting even more the significance of accurate preoperative diagnosis. Surgery, coupled with Albendazole treatment, remains the gold-standard, associated with meticulous intraoperative precautions to prevent disease dissemination.

CONCLUSION

Primary retroperitoneal hydatid cyst is rare. Diagnosis is difficult. Precise determination of patient's background and detailed analysis of imaging findings are mandatory. Percutaneous puncture is forbidden as it leads to disease spreading or even anaphylactic shock. Surgical excision is the gold-standard.

An uncommon way of revelation of a primary diaphragmatic hydatid cyst: A case report

INTRODUCTION AND IMPORTANCE

Diaphragmatic hydatid cyst is a misdiagnosed condition. The challenge is to suspect this rare entity on nonspecific clinical features and to localize the cyst on imaging in order to determine the surgical approach. Surgery is the only curative treatment and confirmation is set on pathology examination.

CASE PRESENTATION

We present the case of a twenty-six-year-old patient, with no medical history, who complained of recurrent right thoracic pains rebel to opioids. All radiological items lead to suspect a diaphragmatic hydatid cyst. Surgery permitted a complete resection of the cyst and a total relief of the pains.

CLINICAL DISCUSSION

The diagnosis of diaphragmatic hydatid cyst is a real challenge. Several diagnoses can be evoked such as hydatid disease depending from the liver, cystic lymphangioma or neural intercostal benign tumor. The phrenic origin of the cyst can only be identified through surgery. However, it is very important to clearly characterize the lesion to well conduct surgical approach.

CONCLUSION

It is important for surgeons to suspect diaphragmatic hydatid cysts despite its rarity. CT-scan and MRI are helpful tools to localize the disease and to conduct the surgical procedure. Final diagnosis is only set on pathology examination after curative surgery.

Acute pancreatitis as an uncommon complication of hydatid cyst of the liver: A case report and systematic literature review

Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. A thirty-year-old woman was referred to our emergency unit for acute pancreatitis. The CT-scan findings revealed a liver hydatid cyst ruptured in the biliary tract and daughter vesicles within were found, responsible for C-grade acute pancreatitis. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative cholangiogram that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence. Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.

Management of a primary retroperitoneal hydatid cyst ruptured in the abdominal wall: A case report

INTRODUCTION

Hydatid disease is a global zoonosis. Any organ of the human body can be involved. Single or multiple locations are reported. However, retroperitoneal hydatid cysts are uncommon. Furthermore, parietal complications are rarely reported in literature. Therefore, the management of hydatid cysts ruptured in the abdominal wall remains challenging.

PRESENTATION OF CASE

In this case report, we aim to describe our experience in treating a primary retroperitoneal hydatid cyst with rupture into abdominal wall in an 87-year-old woman who presented with a 15-centimeter mass of the right flank. Hydatid serology test was positive. An abdominal CT scan showed a 20-centimeter cystic mass of retroperitoneum extended to the abdominal wall with several septa within and enhanced thick wall. The patient underwent a surgical elective drainage with perioperative antiparasitic chemotherapy. Follow-up showed no recurrence.

DISCUSSION

Primary retroperitoneal hydatid cyst with parietal complications is scarce and barely described in literature. We performed a review of the recent relevant literature that deals with this subject. None of the hydatid cysts reported in 55 cases was located in retroperitoneum. The top seven countries of origin are located in Mediterranean region except for India. Imaging is compulsory for the diagnosis along with patient's history, physical examination and hydatid serology. The treatment is surgical and must be must be covered by antiparasitic chemotherapy.

CONCLUSION

Primary retroperitoneal hydatid cyst extended to the abdominal wall remains a rare and challenging diagnosis that must be considered in endemic countries.

Gallbladder Hydatid Cyst: A Review on Clinical Features, Investigations and Current Management

BACKGROUND

Gallbladder hydatid cyst (GBHC) is highly uncommon with an incidence of 0.3-0.4% of all atypically located hydatid cysts. Our personal experience of one case of primary GBHC (PGBHC) managed laparoscopically motivated this systematic review. This study aimed to analyze the demographic characteristics, types [whether primary GBHC (PGBHC) or secondary GBHC (SGBHC)], clinical presentation, laboratory investigations, imaging studies, operative procedure, hospital stay, follow-up and recurrence.

METHODS

A systematic review was performed using preferred reporting items for systematic reviews and meta-analyses guidelines.

RESULTS

Twenty studies, including 22 cases plus one more case managed by us, were included in the review. For PGBHC, the mean age was 48.61 years while for SGBHC it was 47.9 years. PGBHC was more common in females (69.23%) while SGBHC was more common in males (55.55%). Overall, GBHC was more common in females (56.52%). The most common presentation overall was abdominal pain (100%) followed by nausea/vomiting (43.47%). The other common symptoms were nausea/vomiting (61.53%) and Murphy's sign (38.46%) in PGBHC, but jaundice (50%) and fever (30%) in SGBHC. In PGBHC, 50% patients had normal liver function while this was deranged in 66.66% patients with SGBHC. Serology was positive in 50% of PGBHC and 100% in SGBHC. Ultrasonography was positive in 50%, while CT-scan showed 70%. CT-scan was better at detection of SGBHC (100%). The most common operation was open cholecystectomy (78.26%) either isolated or combined. Isolated open cholecystectomy was commonly done in PGBHC (69.23%). Overall, only 56.52% of patients received albendazole, but no recurrence was reported. The average hospital stay was 7.25 days and follow-up ranged from 1 month to 10 years.

CONCLUSION

GBHC mostly affects females with abdominal pain being the most common symptom. Ultrasonography is expedient though CT-scan is more sensitive. Albendazole monotherapy has questionable value. Open cholecystectomy is the most common operation. However, laparoscopy is safe in experienced hands.

Splenic Localization of Primary Hydatid Cyst in a 27-Year-Old Sportsman Treated by PAIR Technique: Imaging Anatomy Assessment

INTRODUCTION

In this paper, we report our experience with a case of primary hydatid cyst involving only the spleen in a 27-year-old sportsman treated by PAIR technique.

CASE REPORT

Five years before, a 27-year-old handball player being admitted to our hospital, it was detected the cyst in his spleen which size was 35 x 30 mm in diameter, by abdominal ultrasound during a systematic examination. There was no pain or any other symptoms at that time. Tests on the presence of echinococcus cysts were negative. After a period of 5 years, and regular check-ups, the patient began to feel a dull pain in the left upper quadrant area. The Echinococcus test was again negative. Puncture and aspiration of content was performed and sent to cytological analysis that confirmed the presence of Echinococcus. The CT finding showed the spleen in a normal position, shape, enlarged, 185 mm in longitudinal diameter (splenomegaly), with inhomogeneous parenchyma on the expense of rounded area with hyperdense halo, which did not opacify after contrast, located in the dorsal area of the spleen, 100x98 mm in diameter and which corresponded to the echinococcal cyst in differential diagnosis-clean dense contents (protein / haemorrhagic).

CONCLUSION

The reported case is very specific, considering that handball is contact sport, where it is almost impossible to avoid the physical contact between players, which is sometimes even rough. Due to rough contacts, spleen trauma is something we should be very aware about, especially in cases of splenomegaly with hydatid cyst, where the spleen rupture might lead to fatal outcome. According to all this, careful follow up of this patient is necessary.

Unusually located primary hydatid cysts

The hydatid disease caused by Echinococcus granulosus is an endemic parasitic disease affecting several Mediterranean countries. Echinococcal cysts are mostly located in the liver and the lung, but the disease can be detected anywhere in the body. In this study, we present uncommon extrahepatic localizations of primary hydatid disease. Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between 2004 and 2010 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung were enrolled in the study. Eight patients with extrahepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in the scapular region, spleen, pancreas, lumbosacral region and gluteal muscle. Surgical techniques were partial or total cystectomy with or without tube drainage. Splenectomy was performed for splenic hydatid disease and partial pericystectomy, Roux-en-Y cystojejunostomy, cholecystectomy and T-tube drainage for pancreatic hydatid disease. There were no complications or mortality in the postoperative period. Hydatid cyst should be considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique should be planned according to the location of the cyst.