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Hammoodi Al obaidi JH. Management of Incidental Rupture of Abdominal Hydatid Cyst. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.02.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abdominal hydatid cyst rupture is one of the critical situations which challenged the surgeon incidentally during explorative lobotomy for acute abdominal conditions. It is considered an endemic area for hydatid disease. To study and evaluate different modalities of surgical treatments used to deal with the incidental rupture of abdominal hydatid cyst. Patient and methodology: Patients (n=200) underwent surgical treatment for abdominal hydatid cysts in Al -Kindy teaching Hospital and Diala private hospital. A review was carried out from January 1996 to January 2006. About 18 patients (6%) had a rupture of abdominal hydatid cyst; in 15 patients (83.3%), the rupture was discovered incidentally during surgery for urgent acute abdomen, and 3 patients (16.7%) were detected clinically and using ultrasound. The median age was 32 years, and the female to male ratio was 2:1. 17 patients presented with signs & symptoms of acute abdomen. 11 patients presented with hypovolaemic shock after trauma to the liver (RTA in 9 patients, anaphylactic shock in 1 patient, allergic reaction in 1 patient). 4 patients presented with spontaneous rupture, 2 presented with secondary hydatidosis, and 1 presented with haematuria. Results: Twelve females and six males were affected. Rupture of abdominal hydatid cyst was diagnosed in only three patients by history, clinical examination, and ultrasound. At the same time, the other 15 patients were diagnosed during surgery. The mean hospital stay was 14 days. About 5 patients developed post-operative complications, i.e., wound infection (n=1), stress ulceration in the duodenum (n=1), subphrenic abscess (n=1), an infected remnant of hepatic hydatid cyst cavity (n=1), and recurrence of the hydatid cyst (n=1). Unfortunately, intra-operative mortality was recorded in 1 patient. The clinical diagnosis is usually tricky, but ultrasonography is an excellent initial diagnosis in suspected cases.
Keywords: Surgical treatment, Incidental Ruptured Abdominal hydatid cyst, Traumatic rupture.
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Dudha M, Shaikh Z, Bhaiyat M, Wadiwala IJ, Bhaiyat ZT. A Case of Echinococcal Cyst of the Lung. Respir Med Case Rep 2018; 25:286-292. [PMID: 30364676 PMCID: PMC6197673 DOI: 10.1016/j.rmcr.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 11/04/2022] Open
Abstract
Echinococcosis, also known as Hydatid disease, is caused by the larvae of the tapeworm Echinococcus. It is globally prevalent and is a major clinical health concern. It is endemic in most underdeveloped regions including Asia, the Mediterranean, South America and Africa. There are four species within the genus Echinococcus, with E. granulosus and E. multilocularis being the most common, causing Cystic Echinococcosis (CE) and Alveolar Echinococcosis (AE). The clinical presentation of the disease is non-specific. It commonly involves the liver, lungs, brain and adrenal glands. Pulmonary disease is significant for its propensity to affect children and young adults. This young population accounts for ∼50% of pulmonary hydatid cysts [1]. Cysts are known to grow extensively in size. Many patients are asymptomatic and have only a solitary cyst. Symptoms arise from enlargement of the cyst and from eroding and pressure applied by the cyst to blood vessels and organs. If rupture of the cyst occurs it can lead to immunologic reactions such as asthma and anaphylaxis. Echinococcus in the lung can pose diagnostic dilemmas, as their homogeneous density and tendency to occur alone may cause them to be confused with squamous cell carcinoma, adenocarcinoma, solitary metastasis, and abscess [2]. Our case is of such a patient who was found to have a 6 cm mass in the right middle lobe (RML) found on a chest X-ray during evaluation of back pain. Echinococcus should always be included in a differential diagnosis of any mass lesions especially in immigrant populations from endemic countries.
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Affiliation(s)
| | - Zakir Shaikh
- Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - Mohammed Bhaiyat
- Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
| | - Ishaq J Wadiwala
- Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India
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Abstract
ABSTRACT
Tuberculosis and hydatidosis are both infectious diseases commonly involving the pulmonary system and exhibiting a wide spectrum of clinical manifestations of varying severity. The simultaneous occurrence of pulmonary tuberculosis and hydatid disease is extremely rare, reported sporadically in the literature. We herein report two cases where this rare coexistence was proven after radiological features aroused suspicion. The first patient was a young female with a short history of fever and cough. She had miliary mottling and a cystic lesion on imaging. Second patient was an elderly lady with a long-standing cough, dyspnea, and hemoptysis. She had multiple cystic and cavitatory lesions on imaging. Both of them were managed with medical therapy successfully. The possibility of hydatid tuberculosis coinfection should be kept in mind in endemic areas in the relevant clinical scenarios.
How to cite this article
Laldayal D, Utpat K, Joshi JM. Unusual Coexistence of Pulmonary Tuberculosis and Hydatid Disease. J Postgrad Med Edu Res 2018;52(1):36-39.
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Ma J, Wang X, Mamatimin X, Ahan N, Chen K, Peng C, Yang Y. Therapeutic evaluation of video-assisted thoracoscopic surgery versus open thoracotomy for pediatric pulmonary hydatid disease. J Cardiothorac Surg 2016; 11:129. [PMID: 27495934 PMCID: PMC4974716 DOI: 10.1186/s13019-016-0525-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/28/2016] [Indexed: 11/30/2022] Open
Abstract
Background Hydatid disease is a severe and widespread human cestode infection, and in children, the lung is the most commonly infected organ. In current practice, the standard surgical procedure for the removal of pulmonary hydatid cysts is thoracotomy; therefore, we evaluated the efficacy and safety of video-assisted thoracoscopic surgery (VATS) to treat pediatric pulmonary hydatid disease. To our knowledge, this is the first and large sample comparative study of VATS and thoracotomy for pediatric pulmonary hydatid disease. Methods In this study, we retrospectively reviewed 44 (61.1 %) pediatric patients who underwent VATS, and 28 (38.9 %) pediatric patients who underwent conventional thoracotomy from January 2005 to June 2012. Perioperative data, including basic characteristics of patients, the length of hospital stay, intraoperative blood loss, thoracic intubation indwelling time, and complications were compared between VATS and thoracotomy in 72 children with pulmonary hydatid disease. Results VATS was found to be a safe technique for the treatment of pediatric pulmonary hydatid disease, with zero intraoperative deaths. In the VATS and thoracotomy groups, the hospital stay durations were 10.50 ± 1.20 days and 17.30 ± 2.75 days, respectively, and occurrence rates of complications were 9.1 % (4/44) and 17.9 % (5/28), respectively. The hospital stays were shorter and the hospitalization costs was reduced for the patients who underwent VATS compared with conventional thoracotomy (P = 0.001). Although no statistically significant difference in the recurrence rates (P = 0.958) and complication incidence (P = 0.273) between the two surgical groups was observed, less intraoperative bleeding, shorter thoracic intubation indwelling time and reduced postoperative pain were observed in the patients who underwent VATS (P = 0.001). Conclusion Our study demonstrates the feasibility and safety of VATS for pediatric pulmonary hydatid disease treatment, providing a practice-changing concept for the treatment of this disease in the community. VATS can be a promising therapeutic tool, by overcoming many of the drawbacks of thoracotomy, and can be used as an alternative to thoracotomy for selected pediatric patients.
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Affiliation(s)
- Jinshan Ma
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People's Republic of China.
| | - Xiaolei Wang
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People's Republic of China
| | - Xaokat Mamatimin
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People's Republic of China
| | - Nuerlan Ahan
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People's Republic of China
| | - Kang Chen
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People's Republic of China
| | - Chuanliang Peng
- Secondary Hospital of Shandong University, Jinan, Shandong, 250000, People's Republic of China
| | - Yongwei Yang
- People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, 830001, People's Republic of China
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Abstract
Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajnish Pathania
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Jhobta
- Department of Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Babu Ram Thakur
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajesh Chopra
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Management of pulmonary hydatid cysts in a tertiary care centre in Northeast India. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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PATHOLOGIE INFECTIEUSE. IMAGERIE THORACIQUE 2013. [PMCID: PMC7156015 DOI: 10.1016/b978-2-294-71321-7.50016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Diagnostic, Surgical, and Medicinal Approaches of Human Cystic Echinococcosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e31826412b7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nakamura K, Ito A, Yara S, Haranaga S, Hibiya K, Hirayasu T, Sako Y, Fujita J. A case of pulmonary and hepatic cystic Echinococcosis of CE1 stage in a healthy Japanese female that was suspected to have been acquired during her stay in the United Kingdom. Am J Trop Med Hyg 2011; 85:456-9. [PMID: 21896804 DOI: 10.4269/ajtmh.2011.11-0112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We herein report a case of a young Japanese female who was confirmed to have cystic echinococcosis (CE) 1 stage based on the World Health Organization Informal Working Group on Echinococcosis pathological classification of CE, and she was also suspected to be infected with eggs of the G1 Echinococcus granulosus sensu stricto during her stay in the United Kingdom and therefore, suffered from synchronous pulmonary and hepatic CE. Oral albendazole was administered initially, but rupture of a lung hydatid cyst was observed. To avoid additional rupture, we performed two surgeries. CE is very rare in Japan; all CE cases in Japan during the past two decades have been confirmed to be imported, and almost all cases are hepatic CE. This case is the first case report of a Japanese patient who had concomitant giant lung and liver CE with early-stage CE1 and was successfully treated by surgery and pharmacotherapy with a serological follow-up.
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Affiliation(s)
- Kiwamu Nakamura
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan.
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Vijayan VK, Kilani T. Emerging and established parasitic lung infestations. Infect Dis Clin North Am 2010; 24:579-602. [PMID: 20674793 DOI: 10.1016/j.idc.2010.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many lung infestations from established and newly emerging parasites have been reported as a result of the emergence of HIV/AIDS, the increasing use of immunosuppressive drugs, increasing organ transplantations, the increase in global travel, and climate change. A renewed interest in parasitic lung infections has been observed recently because many protozoal and helminthic parasites cause clinically significant lung diseases. The diseases caused by these parasites may mimic common and complicated lung diseases ranging from asymptomatic disease to acute respiratory distress syndrome requiring critical care management. The availability of new molecular diagnostic methods and antiparasitic drugs enables early diagnosis and prompt treatment to avoid the morbidity and mortality associated with these infestations. Good hygiene practices, improvement in socioeconomic conditions, vector control measures, and consumption of hygienically prepared and properly cooked food are essential to reduce the occurrence of parasitic infestations.
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Affiliation(s)
- Vannan Kandi Vijayan
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi 110007, India.
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Chacko J, Raot S, Basawaraj K, Chatterjee S. Ruptured hydatid cyst masquerading as tension pneumothorax. Anaesth Intensive Care 2010; 37:840-2. [PMID: 19775053 DOI: 10.1177/0310057x0903700538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a 35-year-old man who presented to us with features suggestive of a tension pneumothorax. However insertion of a chest tube did not result in any signs of improvement. Further investigation demonstrated that he had a ruptured hydatid cyst. He underwent an emergency thoractomy and excision of the cyst. Ruptured hydatid cyst should be considered as a possibility in patients who present with sudden onset respiratory distress and hypoxia in geographical areas where the disease may be prevalent.
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Affiliation(s)
- J Chacko
- Multidisciplinary Intensive Care Unit, Manipal Hospital, Bangalore, Karnataka, India
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Sinmaz E, Çeliksöz A. A Giant pulmonary hydatid cyst treated without lobectomy. Yonsei Med J 2009; 50:856-8. [PMID: 20046431 PMCID: PMC2796417 DOI: 10.3349/ymj.2009.50.6.856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 04/24/2004] [Accepted: 04/24/2004] [Indexed: 11/29/2022] Open
Abstract
A 20 year-old woman was admitted to our clinic complaining of dyspnea, cough, chest pain and pleural effusion. The diagnosis of pulmonary hydatid cyst was made on the basis of parasitology laboratory findings, computed tomographic results and chest radiographic findings. A giant pulmonary hydatid cyst (33x14x12 cm) was located in the left lower lobe, which involved more than 90% of the lobe. The patient was treated surgically using cystotomy and capitonnage. This is a case of a giant pulmonary hydatid cyst published in the literature, which was surgically treated without a lobectomy, by preserving the lung parenchyma.
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Affiliation(s)
- Emrah Sinmaz
- Toracic Surgery Unit, State Hospital, Sivas, Turkey
| | - Ali Çeliksöz
- Department of Parasitology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Surgical treatment of intrathoracic hydatid disease: a 5-year experience in an endemic region. Surg Today 2009; 40:31-7. [PMID: 20037837 DOI: 10.1007/s00595-009-4063-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 04/27/2009] [Indexed: 01/21/2023]
Abstract
PURPOSE To present our recent surgical experience in treating patients with intrathoracic hydatidosis. METHODS This study reviewed the files of patients with pulmonary/intrathoracic extrapulmonary hydatid cysts treated surgically between 2003 and 2009. Demographic, laboratory and radiological data, clinical manifestations, site of the cyst, surgical approaches, and final outcome were noted and analyzed. RESULTS Forty patients underwent 42 operations (21 females, 19 males, mean age 36 years). Thirty-six patients (90%) had pulmonary (56.7% were intact/uncomplicated), three (7.5%) had intrathoracic extrapulmonary, and one (2.5%) had both pulmonary/intrathoracic extrapulmonary hydatid cysts. The right lung was involved in 64.9%. Larger pulmonary cysts ruptured more commonly (P = 0.007). Most patients (95%) were symptomatic, mostly dyspneic (72.5%). The mean forced expiratory volume in 1 s value was significantly reduced in cases with a large (P < 0.0001), or ruptured cyst (P = 0.05). The erythrocyte sedimentation rate was elevated in case of rupture (P = 0.05). A thoracotomy was performed for all patients. A cystotomy and capitonnage was performed more commonly than cystotomy without capitonnage for the pulmonary, and total excision was performed for the intrathoracic extrapulmonary hydatid cysts. The mortality was 0% and the morbidity was 17.5%. All patients received antihelminthic therapy postoperatively. There was no recurrence. CONCLUSION Surgery is considered to be the optimal treatment for intrathoracic hydatid disease. In addition, recurrence is very low when all such patients receive postoperative antihelminthic therapy.
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Arıbaş BK, Dingil G, Köroğlu M, Ungül U, Zaralı AC. Liver hydatid cyst with transdiaphragmatic rupture and lung hydatid cyst ruptured into bronchi and pleural space. Cardiovasc Intervent Radiol 2009; 34 Suppl 2:S260-5. [PMID: 19847481 DOI: 10.1007/s00270-009-9734-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 10/02/2009] [Indexed: 01/20/2023]
Abstract
The aim of this case study is to present effectiveness of percutaneous drainage as a treatment option of ruptured lung and liver hydatid cysts. A 65-year-old male patient was admitted with complicated liver and lung hydatid cysts. A liver hydatid cyst had ruptured transdiaphragmatically, and a lung hydatid cyst had ruptured both into bronchi and pleural space. The patient could not undergo surgery because of decreased respiratory function. Both cysts were drained percutaneously using oral albendazole. Povidone-iodine was used to treat the liver cyst after closure of the diaphragmatic rupture. The drainage was considered successful, and the patient had no recurrence of signs and symptoms. Clinical, laboratory, and radiologic recovery was observed during 2.5 months of catheterization. The patient was asymptomatic after catheter drainage. No recurrence was detected during 86 months of follow-up. For inoperable patients with ruptured liver and lung hydatid cysts, percutaneous drainage with oral albendazole is an alternative treatment option to surgery. The percutaneous approach can be life-saving in such cases.
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Affiliation(s)
- Bilgin Kadri Arıbaş
- Department of Radiology, AY Ankara Oncology Training and Research Hospital, 06200 Ankara, Turkey.
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Lamonaca V, Virga A, Minervini MI, Di Stefano R, Provenzani A, Tagliareni P, Fleres G, Luca A, Vizzini G, Palazzo U, Gridelli B. Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation: An ex-vivo pilot experimental study in animal models. World J Gastroenterol 2009; 15:3232-9. [PMID: 19598298 PMCID: PMC2710778 DOI: 10.3748/wjg.15.3232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate radiofrequency thermal ablation (RTA) for treatment of cystic echinococcosis in animal models (explanted organs).
METHODS: Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80°C, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic.
RESULTS: The subjects of the study were 17 cysts (nine hepatic and eight pulmonary), who were treated with RTA. Pathology showed 100% success rate in both hepatic (9/9) and lung cysts (8/8); immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts.
CONCLUSION: RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in vivo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.
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Recurrent pulmonary hydatid disease: Analysis of ten cases. Surg Today 2008; 38:983-6. [DOI: 10.1007/s00595-008-3759-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 01/21/2008] [Indexed: 11/26/2022]
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Thoracic hydatid disease; a review of 763 cases. Heart Lung Circ 2008; 17:502-4. [PMID: 18676200 DOI: 10.1016/j.hlc.2008.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 03/21/2008] [Accepted: 04/01/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thoracic hydatid disease remains a significant health problem in endemic areas. The aim of this study was to retrospectively evaluate 763 patients diagnosed with thoracic hydatid cysts and treated surgically at Ibn-Alnafis Teaching Hospital between January 1986 and January 2006. METHODS All patients underwent surgery. The mean age was 26 years. Intact cysts were enucleated in 468 patients after injection with a scolicidal agent and the remaining cavity was left open after securing localised air leaks. Pulmonary resections were performed in 198 patients. RESULTS Most cysts were removed without lung resection. Resection was reserved for large cysts, severe suppuration and complicated cases with haemoptysis or bronchiectasis. However, lung preservation was always attempted initially. In patients with intact lung cysts, 37% were asymptomatic with incidental diagnosis on routine chest X-ray. Mortality was 1% and morbidity was 12.6%. CONCLUSION Lung preservation without obliteration of pericystic cavity provides good result in patients with uncomplicated hydatid cysts. Radical resection should be reserved for complicated cases. Medical treatment is indicated postoperatively especially for recurrent or multiple hydatid cysts.
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Al-amran FGY. Surgical experience of 825 patients with thoracic hydatidosis in Iraq. Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-008-0017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gabal AM, Khawaja FI, Mohammad GA. Modified PAIR technique for percutaneous treatment of high-risk hydatid cysts. Cardiovasc Intervent Radiol 2005; 28:200-8. [PMID: 15883860 DOI: 10.1007/pl00021047] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE This paper presents a modification of the known method for percutaneous treatment of hydatid cyst, the PAIR technique. It aimed to achieve safe aspiration of large symptomatic cysts and cysts with a danger of impending rupture. METHODS We designed a coaxial catheter system to achieve concomitant evacuation of cyst contents while infusing scolicidal agent. Hypertonic saline is used to wash out cyst contents and to kill protoscolices. This was followed by injection of a sclerosant (ethyl alcohol 95%) into the residual cyst cavity to prevent formation of a cyst collection after the procedure. Seventeen cysts in 14 patients were successfully aspirated. Follow-up plain radiographs, ultrasonography and CT were performed weekly in the first 4 weeks and then at 3, 6 and 12 months for all patients. Seven patients (9 drained cysts) were followed up for 2 years and 1 patient for 3 years. RESULTS All cysts were successfully aspirated. The following morphologic changes were noticed: a gradual decrease in cyst size (17 cysts, 100%), thickening and irregularity of the cyst wall due to separation of endocyst from pericyst (7 cysts, 41%), development of a heterogeneous appearance of the cyst components (8 cysts, 47%) and development of pseudotumor (2 cysts, 12%). None of the treated cysts disappeared completely. No significant procedure-related complications were encountered. CONCLUSION This modified PAIR technique is a reliable method for percutaneous treatment of risky and symptomatic hydatid cysts.
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Smego RA, Sebanego P. Treatment options for hepatic cystic echinococcosis. Int J Infect Dis 2005; 9:69-76. [PMID: 15708321 DOI: 10.1016/j.ijid.2004.08.001] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2004] [Revised: 08/09/2004] [Accepted: 08/11/2004] [Indexed: 12/13/2022] Open
Abstract
A number of surgical and non-surgical options exist to treat cystic echinococcosis of the liver. For decades, surgical excision via a conservative or radical approach was the recommended approach for hepatic hydatid cysts. The availability of chemotherapeutic agents with significant activity against Echinococcus granulosis has made it possible to undertake ultrasound- or computed tomography-guided transhepatic percutaneous drainage (termed puncture, aspiration, injection, and re-aspiration (PAIR)) of hydatid cysts. Pre- and post-intervention chemotherapy with albendazole or mebendazole offers the advantage of reducing the risk of disease recurrence and intraperitoneal seeding of infection that may develop via cyst rupture and spillage occurring spontaneously or during surgery or needle drainage. PAIR appears to have greater clinical efficacy (i.e. a higher incidence of cure), lower rates of major and minor complications, mortality, and disease recurrence, and fewer days of hospitalization compared to patients treated surgically. For patients who fail drug therapy alone, PAIR is a safe and effective procedure of choice for patients with hepatic echinococcosis, and perhaps other anatomic sites of infection such as lung, peritoneum, kidney, and other viscera. Surgery should be reserved for patients with hydatid cysts refractory to PAIR because of secondary bacterial infection or for those with difficult-to-manage cyst-biliary communication or obstruction.
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Affiliation(s)
- Raymond A Smego
- Department of Medicine, the University of North Dakota, School of Medicine and Health Sciences, Fargo, ND, USA.
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Abstract
A 12-year-old girl presented with hemoptysis, fever and weight loss. She was initially diagnosed and treated for presumed tuberculosis and a lung abscess. Salmonella typhi was isolated from the abscess. Hydatid cyst was diagnosed at surgery. This is the first reported case of a pulmonary hydatid cyst infected with S. typhi.
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Affiliation(s)
- Fawad Aslam
- Aga Khan University Medical College, The Aga Khan University Hospital, Karachi, Pakistan
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Kurkcuoglu IC, Eroglu A, Karaoglanoglu N, Turkyilmaz A, Tekinbas C, Basoglu A. Surgical approach of pulmonary hydatidosis in childhood. Int J Clin Pract 2005; 59:168-72. [PMID: 15854192 DOI: 10.1111/j.1742-1241.2004.00275.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To review the results of different surgical treatment in hydatid disease of the lung in paediatric patients. A total of 102 children with pulmonary hydatid cysts were treated at the our clinic in the period from 1990 to 2001. There were 59 boys and 43 girls and their age ranged from 4 to 16 years (mean 10.2). Chest radiography, computed tomography and abdominal ultrasonography were the most commonly used diagnostic techniques. The cysts were located in the right lung in 68 patients (66.6%), in the left lung in 30 patients (29.4%), in both lungs in four patients (3.9%). Concomitant liver cyst hydatid was also detected in 12 patients that were located at right lung, and two patients with bilateral lung involvement. All cases were managed surgically. Of 14 cases with concomitant liver and intrathoracic hydatid cysts, right thoracophrenotomy was performed in 12, median sternotomy in one, and phrenotomy in other. Partial cystectomy and capitonnage were the most commonly used surgical methods. Post-operative complication was seen in 10 (9.8%) patients. Infection at the incision site occurred in four patients and air leakage in three. Complications of capitonnage were seen in three patients. One patient (1%) died at fourth post-operative day due to sepsis. Parenchyma protective operations should be performed especially in children living in endemic areas because of the possibility of recurrence of the disease in the future. Single stage operations in suitable cases decrease the cost of treatment and make surgical therapy suitable in both children and young adults, by reducing the hospital in-patient time and morbidity.
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Affiliation(s)
- I C Kurkcuoglu
- Department of Thoracic Surgery, School of Medicine, Ataturk University, 25240 Erzurum, Turkey
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Smego RA, Bhatti S, Khaliq AA, Beg MA. Percutaneous aspiration-injection-reaspiration drainage plus albendazole or mebendazole for hepatic cystic echinococcosis: a meta-analysis. Clin Infect Dis 2003; 37:1073-83. [PMID: 14523772 DOI: 10.1086/378275] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Accepted: 06/15/2003] [Indexed: 12/13/2022] Open
Abstract
Using meta-analysis methodology, we compared the clinical outcomes for 769 patients with hepatic cystic echinococcosis treated with percutaneous aspiration-injection-reaspiration (PAIR) plus albendazole or mebendazole (group 1) with 952 era-matched historical control subjects undergoing surgical intervention (group 2). The rate of clinical and parasitologic cure (P<.0001) was greater in patients receiving PAIR plus chemotherapy. Disease recurrence (P<.0001), major complications (anaphylaxis, biliary fistula, cyst infection, liver/intra-abdominal abscess, and sepsis; P<.0001), minor complications (P<.0001), and death (P<.0824) occurred more frequently among surgical control subjects. Fever (P<.002) and minor allergic reactions subjects (P<.0001) were more common among PAIR-treated subjects. The mean durations of hospital stay were 2.4 days for group 1 and 15.0 days for group 2 (P<.001). Compared with surgery, PAIR plus chemotherapy is associated with greater clinical and parasitologic efficacy; lower rates of morbidity, mortality, and disease recurrence; and shorter hospital stays.
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Affiliation(s)
- Raymond A Smego
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Turna A, Yilmaz MA, Haciibrahimoğlu G, Kutlu CA, Bedirhan MA. Surgical treatment of pulmonary hydatid cysts: is capitonnage necessary? Ann Thorac Surg 2002; 74:191-5. [PMID: 12118757 DOI: 10.1016/s0003-4975(02)03643-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hydatid disease of the lung caused by Echinococcus granulosus is frequently encountered in Mediterranean countries. The ideal surgical method for treating this disease is still unknown. METHODS Between 1994 and 2001, 71 patients with pulmonary hydatid cysts were treated surgically. There were 41 male and 30 female patients with a mean age of 30.2 years (range, 5 to 70 years). Cystotomy and closure of bronchial openings were performed in all patients. Obliteration of the residual cavity by imbricating sutures from within (capitonnage) was achieved in 39 patients (group 1). There were 34 patients with intact cysts and 37 patients with at least one complicated cyst. The average diameter of the cysts was 6.4 cm, and the mean number of cysts per patient was 1.4. The surgical outcome was assessed in group 1 patients and in patients who had undergone closure of bronchial openings without capitonnage (group 2; n = 32). The groups were comparable in regard to clinical characteristics. RESULTS There was no mortality. The total hospitalization time (mean +/- standard error of the mean) was 5.0 +/- 5.0 days for group 1 and 5.9 +/- 6.9 days for group 2 (p = 0.91). Stay in the intensive care unit was 1.64 +/- 1.22 days in group 1 and 1.60 +/- 1.52 days in group 2 (p = 0.90). The duration of air leak was 2.56 +/- 4.73 days in group 1 and 2.38 +/- 4.74 days in group 2 (p = 0.87). There was no significant difference between groups in the development of empyema (1 patient in group 2 only) and prolonged air leak (5 patients in group 1 and 4 in group 2). There was also no significant difference in the rate of recurrence (3 patients in group 1 only). CONCLUSIONS We conclude that capitonnage provides no advantage in operations for pulmonary hydatid cysts.
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Affiliation(s)
- Akif Turna
- Department of Thoracic Surgery, Yedikule Hospital for Chest Disease and Thoracic Surgery, Zeytinburnu, Istanbul, Turkey.
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Abstract
Two Echinococcus species may exhibit medical relevance as causative agents of pulmonary forms of echinococcosis. Most importantly, infections with Echinococcus granulosus result in "cystic hydatid disease" or "cystic echinococcosis," which affects the lungs in a considerable ratio of cases. Echinococcus multilocularis, which causes "alveolar echinococcosis," affects the lungs relatively rarely and then usually upon metastasizing from primary hepatic lesions. Cystic echinococcus and alveolar echinococcus differ pathologically and clinically so greatly that they are considered separately in this article, although alveolar echinococcus is covered minimally because of its minor importance regarding lung infections.
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Affiliation(s)
- Bruno Gottstein
- Institute of Parasitology, University of Berne, Länggass-Strasse 122, CH-3012 Berne, Switzerland.
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Affiliation(s)
- R P Scott
- Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-1999. A 34-year-old woman with one cystic lesion in each lung. N Engl J Med 1999; 341:974-82. [PMID: 10498494 DOI: 10.1056/nejm199909233411308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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