Management of peritoneal hydatid cysts: A fourty-year experience

Cystic echinococcosis of the liver

BACKGROUND

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm, which is transmitted by dogs and found on every continent, except Antarctica. This study aimed to review the life cycle, epidemiology, symptoms, diagnostic methods, and treatment of E granulosus infection of the liver.

METHODS

A comprehensive review was conducted using MEDLINE/PubMed, Google Scholar, Cochrane Library, and the Web of Science, which were accessed between 1990 and 2024. The main search focused on "CE of the liver." The following terms were used: cystic echinococcosis, hydatidosis, E granulosus, echinococcus life cycle, liver cyst, albendazole, liver resection, pericystectomy, cystobiliary fistula, and percutaneous aspiration injection and reaspiration (PAIR).

RESULTS

CE should be considered in the differential diagnosis of hepatic cysts, especially among individuals with risk factors, such as those who have traveled to or immigrated from areas with a high prevalence. Echinococcus species require 2 hosts to complete their life cycle, with humans acting as intermediate hosts that become infected by ingesting eggs from contaminated environments, leading to cyst formation, typically in the liver or lungs. Symptoms are based on cyst size and location, such as abdominal pain, jaundice, respiratory distress, or neurologic deficits, and can lead to severe complications, such as cyst rupture, allergic reactions, sepsis, or secondary hydatidosis. Imaging plays a key role in evaluating cyst stage, size, location, and potential complications and in determining the appropriateness of a minimally invasive PAIR procedure. Although serum antibody tests typically have a low sensitivity, antigen assays or recombinant proteins may provide useful diagnostic information. For uncomplicated active cysts, the treatment options include chemotherapy alone or in combination with the PAIR technique.

CONCLUSION

Hepatic echinococcal cysts, which are relatively rare in North America, should be considered in the differential diagnosis of hepatic cysts, especially in individuals with risk factors.

Primary intraperitoneal hydatid cyst presenting with abdominal distension: A case report

INTRODUCTION

Peritoneal hydatid disease accounts for 2-13 % of abdominal hydatidosis cases. Due to its nonspecific clinical presentation and potential for multi-organ involvement, the condition is often misdiagnosed. Evidence on managing primary peritoneal hydatid cysts remains limited, presenting challenges in diagnosis and treatment.

PRESENTATION OF CASE

We report a case of primary peritoneal hydatid in a patient, who presented with abdominal distension for a year. Surgical excision and postoperative treatment with albendazole were effective in controlling the disease and preventing a recurrence.

DISCUSSION

The primary goals of treatment are to eliminate the disease, prevent complications, and reduce recurrence risks. Controlled open surgery is preferred for peritoneal echinococcosis to minimize spillage and dissemination. Adjuvant anthelmintic therapy, such as albendazole, prevents recurrence.

CONCLUSION

In patients presenting with abdominal cystic masses, especially in endemic regions, hydatid disease should be considered in the differential diagnosis. Complete excision of the hydatid cyst combined with antiparasitic therapy is crucial to prevent recurrence.

Disseminated hydatidosis an unusual presentation: a case report

Hydatidosis, also known as cystic echinococcosis, is a widespread zoonosis, caused by a tapeworm of the genus Echinococcus. It presents a significant public health concern, particularly in endemic areas. The occurrence of disseminated hydatid disease is uncommon, even in regions where it is endemic, with an incidence ranging from 1-8%. The definitive diagnosis relies on a parasitological method. In this work, we present an unusual case of disseminated hydatid disease that was diagnosed in the central parasitology-mycology laboratory of 'The Ibn Sina University Hospital'. This is a 21-year-old patient residing in a rural area, who presented with heaviness-type pain in the right hypochondrium, accompanied with nausea and vomiting. During the examination, the patient mentioned the contact with dogs. Abdominal radiography (ultrasound and CT) revealed findings suggestive of multiple hydatid cysts located in the liver and peritoneum. This suspicion was confirmed by positive hydatid serology. After 9 months of treatment with albendazole, the patient underwent surgery for excision of the cysts shown on the x-ray, as well as other cysts incidentally discovered intraoperatively at the pelvic and rectal levels. All of the extracted specimens were sent to the parasitology laboratory. The direct examination, along with the viability test, revealed the presence of hooks and scolex of non-viable Echinococcus granulosus. Disseminated hydatidosis is a rare but serious presentation, and the positive diagnosis relies on several epidemiological, clinical, radiological and parasitological arguments. Medical and surgical treatments play a crucial role in determining the patient's prognosis.

Encysted Odyssey: A Clinical and Pictorial Analysis of Hydatid Cysts From Head to Toe

INTRODUCTION

Cystic echinococcosis, a zoonotic disease caused by the larval form of Echinococcus granulosus, predominantly affects the liver and lungs, with humans acting as accidental hosts.

METHODS

Our retrospective study at the Department of Radiology and Imageology, Nizam's Institute of Medical Sciences, included 187 histopathologically or serologically proven cases. The mean age of presentation was 49.4 years.

RESULTS

Liver involvement was most prevalent, accounting for 83.4% (n=156) of cases, followed by sporadic involvement of other organs such as the mesentery, spleen, pancreas, thalamus, kidney, lung, spine, and omentum. Characteristic diagnostic features observed on imaging included peripheral calcifications in 33% of cases, internal septations in 25% (n=47), dense calcifications in 15% (n=29), daughter cysts in 6% (n=11), and floating membranes in 5% (n=10). Among hepatic lesions, 90% (n=141) were showing involvement of a single lobe. Notably, 78% (n=110) of lesions were limited to the right lobe, 21% (n=30) to the left lobe, and 1% (n=1) to the caudate lobe. The most affected hepatic segment was segment VIII, while the least common was segment I (caudate lobe). Complications were identified in 13% (n=25) of cases of hepatic hydatidosis.

CONCLUSIONS

The findings of our study emphasize the systemic nature of E. granulosus infection which can affect various organs in the body. It also illustrates the invaluable insights imaging provides for timely and accurate diagnosis of hydatid disease.

Anatomical-Based Imaging of Cystic Echinococcosis and Review of the Current Literature

Echinococcosis is a zoonosis caused by cestodes of the genus Echinococcus. This serious disease continues to be an important public health problem as it is endemic in many parts of the world. Cystic disease affects many organs in the body, most commonly the liver. Hydatid disease can cause a diverse spectrum of symptoms, from asymptomatic infection to potential death. In the presence of clinical suspicion, the diagnosis is made by serology and imaging methods. Imaging findings can range from completely cystic lesions to completely solid appearance and calcification. The imaging method to be used depends on the involved organ and the stage of the cyst. The updated recommendations of the World Health Organization-Echinococcosis Informal Working Group for the stage and treatment of human echinococcosis have had important implications. Accordingly, there are 4 approaches to the clinical management of hydatid disease: surgery, percutaneous techniques and drug therapy for active cysts, and a "watch and wait" approach for inactive cysts. Since it directly affects the treatment, it is necessary to be familiar with the imaging findings of the cyst, especially in endemic areas.

Secondary disseminated intraperitoneal hydatid cyst: A case report

Introduction

Hydatidosis is an uncommon zoonotic infection in the Philippines with only a few reported cases. It frequently presents as benign liver cysts with variable symptoms often related to mass effect.

Case presentation

We present a 49-year-old male with a significant travel history from East and Central Asia, surgically treated twice as a benign liver cyst and now presenting with recurrent multiple intraabdominal cysts. He subsequently underwent surgical excision of multiple hydatid cysts with prolonged albendazole treatment. The patient presently remains disease-free as of most recent follow-up.

Discussion

The disease is caused by the tapeworm Echinococcus granulosus and transmission happens when humans acting as intermediate host ingest food contaminated with the parasite eggs, resulting to the liver being the most common location. Frequently, it manifests and is treated as incidental hepatic cysts for the disease is characterized to have a long asymptomatic period. Symptoms are variable and may range from having abdominal pain, increasing abdominal girth, vomiting, fever or myalgia. Ultrasound or CT scan reveals single or multiple cysts however, biopsy of the cyst wall with demonstration of the larval form (protoscoleces) is diagnostic.

Conclusion

This case highlights the value of history-taking and having a high-index of suspicion particularly for rare cases.

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Hydatidosis is a rare disease in South East Asia, particularly the Philippines.

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A high-index of suspicion with significant travel or exposure in prevalent areas is often required to arrive at the diagnosis of Echinococcosis.

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Cystic echinococcosis often presents as benign liver cysts with variable symptoms often related to mass effect.

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Antihelminthics remains to be the treatment of choice with overall excellent prognosis.

Solitary pelvic primary intraperitoneal hydatid managed with a minimal access approach: A case report

Solitary primary pelvic intraperitoneal hydatid cysts are rare. We report the case of a 22-year-old women who presented with a dull ache in her lower abdomen for 2 years and increased urinary frequency over 3 months. Ultrasonography and CT indicated a solitary primary peritoneal pelvic hydatid cyst. Hydatid serology was positive. Perioperative albendazole was prescribed and laparoscopic cystectomy planned. Intraoperatively, dense adhesions to the omentum, urinary bladder, and left fallopian tube were taken down laparoscopically. A small Pfannenstiel incision was made to separate the bladder's left lateral edge and deliver the cyst externally. This report details our experience of managing this case and reviews pertinent literature.