The role of perioperative endoscopic retrograde cholangiopancreatography and biliary drainage in large liver hydatid cysts

Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project

The neglected zoonosis cystic echinococcosis affects mainly pastoral and rural communities in both low-income and upper-middle-income countries. In Europe, it should be regarded as an orphan and rare disease. Although human cystic echinococcosis is a notifiable parasitic infectious disease in most European countries, in practice it is largely under-reported by national health systems. To fill this gap, we extracted data on the number, incidence, and trend of human cases in Europe through a systematic review approach, using both the scientific and grey literature and accounting for the period of publication from 1997 to 2021. The highest number of possible human cases at the national level was calculated from various data sources to generate a descriptive model of human cystic echinococcosis in Europe. We identified 64 745 human cystic echinococcosis cases from 40 European countries. The mean annual incidence from 1997 to 2020 throughout Europe was 0·64 cases per 100 000 people and in EU member states was 0·50 cases per 100 000 people. Based on incidence rates and trends detected in this study, the current epicentre of cystic echinococcosis in Europe is in the southeastern European countries, whereas historical endemic European Mediterranean countries have recorded a decrease in the number of cases over the time.

A Challenging Case of Refractory Biliary Leak in a Patient With Hydatid Liver Disease

Hydatid liver disease (HLD) is the most common form of hydatid disease, and it is caused by a zoonotic infection with a tape worm. It is endemic mostly in sheep-farming countries and rare in the United States. Liver involvement is usually asymptomatic, but symptoms develop upon growth of the cyst leading to many complications, most common of which is intra-biliary rupture, and less likely biliary obstruction. Diagnosis is clinical, serologic and radiologic. Therapeutic approaches to HLD include surgery, anthelminthic medications and medico-surgical procedures. Here we present a case of HLD that presented in advanced stage leading to grave consequences, complicated course and difficult therapeutic options. Given the rarity of hydatid disease in Northern America, physicians have to keep high index of suspicion especially in a patient with history of travel to endemic areas, as early diagnosis and treatment is important to avoid high morbidity and mortality.

ERCP treatment of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy. A case report

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Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcosis of which 50%–75% of hydatid cysts occur in the liver.

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In approximately one-fourth of the cases, hepatic hydatid cyst ruptures into the biliary tree producing obstructive jaundice.

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Moreover, primary hydatid cysts of the biliary tract have been reported in English literature.

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This is an interesting and intriguing case of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy.

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ERCP represent an important management strategy for patients with hydatid cysts in extra-hepatic ducts even primary or complications of liver hydatid cyst.

Introduction

Hydatid disease affects most commonly the liver, and complications with the rupture into the biliary tree develop in approximately one-fourth of the cases. Moreover, primary hydatid cysts of the biliary tract have been reported.

Presentation of case

We report an extremely rare case of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy treated by Endoscopic retrograde cholangiopancreatography (ERCP). A 28-year-old male patient who had undergone surgical treatment – removal of liver hydatid cyst 13 years earlier, presented with signs of obstructed jaundice, confirmed with blood tests results and magnetic resonance cholangiopancreatography (MRCP). Actually, there were no pathological changes detected in the hepatic parenchyma, but the intrahepatic and extrahepatic bile ducts were dilated. ERCP was performed and the entire hydatid material was evacuated and washed out into the gastrointestinal tract. In addition, after laparoscopic cholecystectomy, hydatid cysts were also confirmed in the gallbladder.

Discussion

Generally, the obstructive jaundice caused by hydatid cyst in the extrahepatic ducts can also be caused by the rupture of the liver hydatid cyst in the biliary tract, or by primary hydatid cyst in the biliary tract. The ERCP plays a key role in the diagnosis and the treatment of this pathology.

Conclusion

The ERCP, has now become an important diagnostic and therapeutic procedure in management of primary extrahepatic hydatid cysts and of complicated liver hydatid cysts.

Analysis of Early and Distant Results of Various Options for Eliminating the Residual Liver Cavity Following Echinococcectomy

Introduction. The available literature on the surgery of echinococcosis is mainly presented by retrospective studies, and the results of these studies are often contradictory, especially when it comes to options for the elimination of the residual cavity after removal of the parasitic liver cyst. In this regard, the main purpose of this work is to evaluate the effectiveness of various ways to eliminate the residual liver cavity after echinococcectomy.Materials and methods. The Republican clinical hospital was the host (city of Ufa, Russia) to conduct a prospective analysis of 234 cases of laparotomic surgical removal of echinococcal cysts in the period from 2000 to 2017. The patients were divided into three groups depending on the surgical tactics to solve the problem of residual liver cavity: the first group (n = 84) patients underwent capitonnage and intussusception of the fibrous capsule of the residual cavity; in the second (n = 79) group the greater omental pedicle flap was tamponaded; in the third (n = 71) group underwent the maximum possible excision of the fibrous capsule and the remaining empty space in the liver was opened into the abdominal cavity.Results and discussion: The suppuration of the residual cavity, being the most frequent complication encountered in our study, with almost the same frequency was noted in both groups of patients, where the elimination of the residual cavity was carried out by capitonnage or greater omentum tamponading. According to multifactorial analysis, infectious complications and recurrence of echinococcus were statistically lower in group III than in other groups (p = 0.002 and 0.001; p = 0.004 and p = 0.002).Conclusion. The findings showed that the safest option for “frugal” echinococcectomy was the maximum possible excision of the fibrous cap with subsequent aplatisation. This approach was characterised by the least number of infectious complications and did not require repeated interventions.