Minimal access surgery for multiorgan hydatid cysts

Multi-organ/disseminated echinococcosis in children: Case series and review of the literature

AIM

Echinococcosis with multi-organ/disseminated involvement is rare in childhood. We aimed to evaluate the clinical and laboratory characteristics and prognosis in paediatric patients with echinococcosis having multiorgan/disseminated involvement.

METHOD

We evaluated retrospectively children with echinococcosis with involvement of three or more organs.

RESULTS

Thirteen patients were included in the study. The median age was 120 (range 71-189) months. Three (23%) were diagnosed incidentally. Abdominal pain was seen in 5 (38.4%) patients, vomiting in 4 (30.7%), headache in 3 (23%), cough in 2 (15.3%), groin pain in 1 (7.6%), 1 (7.6%) had jaundice and 1 (7.6%) had fever. The median duration of complaints was 48 (0-140) days. The most common tripartite organ was 38.4% (5/13) liver, lung and spleen. Isolated abdominal dissemination was detected in two patients. Two patients had multi-organ involvement and multiple cysts with dissemination. Cyst rupture was observed in three of the patients; recurrent urinary tract infection, hydroureteronephrosis, secondary peritonitis with intra-abdominal abscess, and biliary tract fistula were each observed in one patient. Relapse developed in 3 (23%) patients.

CONCLUSION

Echinococcosis is a very slow growing and complex parasitic disease that affects many organs and tissues. In our study, eosinophilia, recurrence, and complications were seen at a higher rate in paediatric patients with multiorgan involvement, who required repetitive surgeries and long-term medical treatment. However, there are scanty data on risk factors, optimum treatment and prognosis.

Primary Disseminated Hydatid Disease Involving Multiple Organs in a Pediatric Patient: A Rare Case Report

Hydatid disease is a parasitic infestation by Echinococcus genus of tapeworm, resulting from ingestion of tapeworm eggs and leading to formation of cysts predominantly in the liver and lungs. Multiorgan involvement in children is unusual. We present a case of a 12-year-old female with multiple organ involvement. Patient had history of abdominal pain, breathlessness, irritability and vomiting. Plain radiograph showed a large ovoid calcific lesion projected over the liver. Abdominal sonography demonstrated multiple hydatid cysts in the liver, spleen and left kidney. Ultrasound findings were further confirmed by contrast-enhanced computed tomography that showed additional hydatid cysts in bilateral lungs. All accessible cysts were excised on laparotomy. Cystic hydatid disease should be suspected in all pediatric patients with multiple cystic lesions, especially in endemic areas.

Case Report: Laparoscopic Excision of a Primary Giant Splenic Hydatid Cyst: Literature Review

Cystic echinococcosis (CE), also known as hydatid cyst, is a zoonosis caused by the tapeworm Echinococcus granulosus. It is a common health problem in many countries. This condition predominantly affects the liver and the lungs, and the spleen to a less extent (splenic hydatid cyst, SHD). Indeed, it is estimated that SHD occurs in less than 2% of abdominal CE and 0.5-8% of CE cases. Here, we present a case of a 44-year-old Chinese woman with primary giant SHD who experienced pain in the left hypochondrium for 10 days. A combination of abdominal ultrasonography and computed tomography (CT) were used for preoperative diagnosis. Laparoscopic splenectomy was performed without any complications, and albendazole (400 mg per day) was administered postoperatively for 3 months. At 3-, 6-, 12-, and 24-month follow-up, the patient remained symptoms free, and abdominal CT found no signs of recurrence. In addition to this case, we review the previous literature on SHD treated by laparoscopy and reveal that laparoscopic approach is safe and effective for SHD. Particularly, we show that laparoscopic splenectomy is feasible for giant cysts (> 10 cm) at high risk of rupture or compressing other vital structures.

Disseminated Hydatid Disease in a Child Involving Multiple Organ Systems: A Case Report

Hydatid disease is a parasitic infestation by Echinococcus granulosus, which involves the liver and lungs primarily. The authors report a case of disseminated hydatid disease involving multiple organs simultaneously in a 7-year-old child from Kabul, Afghanistan. The patient under examination had been having a complaint of cough and low-grade fever for the last one year. Computed tomography (CT) and ultrasonography (USG) demonstrated cystic lesions in his liver, lungs, spleen, and suprarenal region. The literature review showed that it was very rare for hydatid disease to involve multiple organs simultaneously, even in endemic areas, and the management of disseminated disease was very challenging, especially in the pediatric population.

Primary Giant Splenic Echinococcal Cyst Treated by Laparoscopy

Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rarer and its primary involvement occurs in less than 2% of abdominal CE. We report a case of primary giant splenic hydatid cyst in a 75-year-old Peruvian woman that was laparoscopically removed without any complications, perioperative prophylactic chemotherapy with albendazole 400 mg twice a day 5 days before, and 7 days after the surgical procedure was administered, postoperative recovery was uneventful, and; at her 3-month follow-up the patient remains asymptomatic and an abdominal computed tomography scan demonstrated a cystic cavity of 15 cm diameter with no daughter vesicles, neither other abdominal organ involvement. This case is in line with the existing literature on laparoscopical treatment of splenic cystic hydatid disease, suggesting that laparoscopical treatment is a safe and effective approach for large splenic hydatid cysts to be preferred to open surgical techniques.

World review of laparoscopic treatment of liver cystic echinococcosis--914 patients

OBJECTIVE

The aim of this study was to provide a review of the world literature on the laparoscopic treatment of liver hydatid cyst.

METHODS

We conducted a literature search using PubMed, screening all English language publications on the laparoscopic treatment of liver hydatid cysts. Operative characteristics, perioperative morbidity, and clinical outcomes were tabulated.

RESULTS

A total of 57 published articles including 914 patients with 1116 hydatid cysts were identified. Of the resections done in the 914 patients, 89.17% were performed totally laparoscopically and 5.58% were gasless. The most common procedure was cystectomy (60.39%), followed by partial pericystectomy (14.77%) and pericystectomy (8.21%); the rest were segmentectomies. Conversion to open laparotomy occurred in 4.92% of reported cases (45/914). The common cause of conversion was anatomical limitations/inaccessible locations (16/45). The overall mortality was 0.22% (2/914 patients) and morbidity was 15.07%, with no intraoperative deaths reported. The most common complication was bile leakage (57/914). The postoperative recurrence was 1.09% (10/914 patients).

CONCLUSIONS

The laparoscopic approach is safe with acceptable mortality and morbidity for both conservative and radical resections in selected patients. Clinical outcomes are comparable to open surgery, albeit in a selected group of patients.

Minimal invasive treatment of abdominal multiorgan echinococcosis

Hydatid disease is a severe zoonosis, exerting a high economic and social impact through its numerous complications, leading to disabilities, even death. Because of technical developments, especially the increasing experience of surgeons, laparoscopic surgery has been extended so that it can be successfully applied to abdominal hydatid cysts. We present the case of a 16-year-old patient who came to our clinic for upper abdominal pain. The abdominal ultrasonography and computed tomography (CT) showed 2 cyst-like tumors, with hydatid features: one affecting the eighth liver segment and the other located at the upper pole of the spleen. We performed the surgical intervention using a laparoscopic approach, with an uneventful postoperative follow-up and the patient was discharged home on postoperative day 4. The postoperative images at 6 and 12 months showed a decrease in size of the remnant cystic cavities.

Hydatid disease in childhood: revisited report of an interesting case

Hydatid disease is a zoonosis caused by the tapeworm of Echinococcus spp. The disease is widely endemic in many sheep and cattle rearing locales. However, hydatidosis does not remain restricted to endemic geographical locales anymore but rather is a global health concern. It is a major public health burden causing significant morbidity and mortality. Echinococcus granulosus involvement in children has a different pattern than adults. Children of all age groups are susceptible and localization of the disease in the lungs is more commonly seen. Multiple liver cysts in the paediatric age group is relatively uncommon. We report an interesting case of multiple liver cysts in a 5-year old boy which was diagnosed as hydatid cysts on histopathological examination.

Laparoscopic cystectomy for splenic hydatid cyst: a case report

Even in countries where it is considered endemic, splenic hydatid cyst is a very rare disease in childhood. Partial or total splenectomy has generally been the treatment of choice for this condition. This is the first report of laparoscopic cystectomy as treatment of isolated splenic hydatid cyst in childhood. A 10-year-old girl with isolated splenic hydatid cyst was successfully treated by laparoscopic cystectomy and splenic preservation. The authors have demonstrated that laparoscopic cystectomy for an isolated splenic hydatid cyst is technically feasible, safe, and is associated with a shorter hospital stay and good cosmetic appearance.

Laparoscopic management of a large primary retroperitoneal hydatid cyst

Hydatid cysts usually involve the liver and lungs, but any other organ can potentially be involved and these can mimic numerous pathologies; however, primary involvement of the retroperitoneum and presentation as a left-sided abdominal mass is quite unusual. A 30-year-old male presented with a large cystic lump in the left side of the abdomen that was diagnosed as a primary retroperitoneal hydatid cyst by a computed tomography scan and serology. The patient was managed successfully by minimal access surgery. This report highlights that a primary retroperitoneal hydatid cyst is a rare clinical entity and should be considered as one of the differential diagnoses in patients presenting with a cystic mass in the retroperitoneum. In the present era of minimal access surgery, it can be safely managed with a laparoscopic approach.