Thoracoscopic Transdiaphragmatic Excision of Hepatic Hydatid in Patients with Synchronous Pulmonary Hydatid: A Novel Operative Approach

Atypical respiratory symptoms due to hepatic hydatid cyst: A case report of emergency surgery

INTRODUCTION

Cystic Echinococcosis (CE), caused by Echinococcus granulosus, primarily affects the liver and lungs, particularly in endemic regions. While commonly associated with gastrointestinal manifestations, CE can lead to severe complications that necessitate surgical intervention.

CASE PRESENTATION

A 53-year-old female was referred due to a prolonged history of exertional dyspnea that recently worsened. Imaging studies indicated a large hydatid cyst in the right lobe of the liver and significant pleural effusion. Surgical management was conducted via thoracotomy, facilitating the excision of multiple cysts and drainage of the pleural fluid.

DISCUSSION

This case illustrates the potential for respiratory symptoms to emerge from hydatid cyst infections, which often present with digestive issues. Effective diagnostic techniques are crucial for identifying the cysts and assessing their impact on surrounding structures. The surgical intervention not only relieved the patient's symptoms but also mitigated the risk of further complications associated with untreated cysts.

CONCLUSION

The findings underscore the importance of recognizing atypical presentations of hepatic hydatid cysts. Timely surgical intervention was essential in managing the patient's condition, highlighting the critical role of prompt diagnosis and treatment in preventing serious complications.

Single-stage versus two-stage surgery of pulmonary and hepatic hydatid cysts

Introduction

Concomitant lung and liver hydatid cyst is a rare condition. Most surgeons agree that both sites should be resected in one-time surgery.

Aim

We present a case series of hepatic and pulmonary hydatid cyst treated in one-stage surgery (OSS) compared with patients who underwent two-stage surgery (TSS).

Material and methods

This retrospective study included 47 patients separated into two groups (33 TSS and 14 OSS) between 2008 and 2019. Data on clinical symptoms, sites, radiological features, techniques, postoperative complications, mean hospital stay and outcome were analyzed separately for TSS and OSS procedures.

Results

A total of 33 patients who underwent TSS (70.2%) were compared to 14 patients operated on by OSS (29.8%). No significant differences were found between groups for age (45.3 vs. 42.7, p = 0.45), sex (male: 57.6% vs. 64.2%) and socio-geographic status (urban: 72.7% vs. 78.6%). But there were more postoperative complications (24.3% vs. 14.3%, p = 0.036) in the TSS group, and operative duration (154 minutes vs. 122 minutes, p = 0.047), postoperative hospital stay (13.8 days vs. 8.7 days, p = 0.022), and interruption of activities and work (56 days vs. 31 days, p = 0.045) were longer in the TSS group. There was no difference in postoperative mortality between the 2 groups.

Conclusions

Single-stage surgical management by trans-thoraco-phrenotomy can be recommended to treat dual-seat hepatic and pulmonary hydatid disease with fewer complications and a rapid return to work. This technique is easier and safer for right lung and liver dome hydatid cysts.