Gallbladder Hydatid Cyst: A Review on Clinical Features, Investigations and Current Management

Cholangiohydatidosis. Clinical features, postoperative complications and hospital mortality. A systematic review

BACKGROUND

Cholangiohydatidosis (CH) is an evolutionary complication of hepatic cystic echinococcosis, associated with increased morbidity and mortality. The aim of this study was to describe the available evidence regarding clinical characteristics of CH, postoperative complications and hospital mortality.

METHODOLOGY/PRINCIPAL FINDINGS

Systematic review. Studies related to CH with no language or publication restriction were included. Sensitive searches were performed in Trip Database, SciELO, BIREME-BVS, WoS, PubMed, EMBASE and SCOPUS. MeSH and free terms were used, including articles up to April 2023. The main outcome variables were postoperative complications and hospital mortality; the secondary ones were publication year, origin and design of primary studies, main clinical manifestation, anatomical location and type of cysts, hospital stay, surgical procedure performed, reinterventions; and methodological quality of primary studies, which was assessed using MInCir-T and MInCir-P scales. Descriptive statistics, calculation of weighted averages and their comparison by least squares logistic regression were applied. 446 studies were retrieved from the searches performed, 102 of which met the inclusion and exclusion criteria. The studies analyzed represent 1241 patients. The highest proportion of articles was published in the last decade (39.2%). Reports are mainly from Turkey (28.4%), Greece (9.8%), Morocco and Spain (8.8% each). With a weighted mean of 14.3 days of hospital stance; it was verified that 26.2% of patients developed postoperative complications (74,3% Clavien y Dindo III y IV), 6.7% needed re-interventions, and 3.7% died. When comparing the variables age, postoperative complications, hospital mortality, and reinterventions in two periods of time (1982-2006 vs. 2007-2023), no statistically significant differences were found. When applying the MInCir-T and MInCir-P scales, the methodological quality of the primary studies was 9.6±1.1 and 14.5±4.3 points, respectively.

CONCLUSION/SIGNIFICANCE

CH is associated with severe postoperative complications and significant hospital mortality, independent of the development of therapeutic support associated with the passage of time.

Liver hydatidosis disease with portal vein invasion: Report of a rare case and review of literature

Hydatid disease is a zoonosis caused by Echinococcus granulosus. Humans are aberrant intermediate hosts and following the infection, the parasite may infest any organ of the body, with the liver and lungs being the most involved organs. Portal vein involvement by hydatid cyst disease is extremely rare with only seven cases published to our knowledge. We present a 62-year-old Persian male with an incidental liver cyst. His laboratory tests were in normal ranges. The ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) findings show hydatid disease of the liver with distal portal vein involvement and collateral venous formations. The patient is being followed and has not gone under surgery yet. It possesses a propensity to invade multiple organ systems, notably the liver and lungs. Hydatid disease is imposing a significant burden on healthcare systems specifically in developing countries. Manifestations of the disease are often non-specific, while a subset of the infected population remains asymptomatic. Portal vein invasion and obstruction is a rare complication, and it is important to distinguish it from vein thrombosis, as the management of these entities requires different approaches.

A rare case of gallbladder cystic echinococcosis disease in western China

Hydatid disease, also known as echinococcosis, is an endemic zoonotic parasitic disease caused by larvae of the Echinococcus tapeworm.Humans as accidental intermediate hosts in the parasite life cycle, echinococcus usually parasitizes the liver, solitary cystic echinococcosis in the gallbladder is very rare. Here we report a rare case of cystic echinococcosis in the gallbladder without liver involvement. A female patient was admitted to the hospital primarily for "right upper abdominal pain with radiating pain in the back of the shoulder for 20 days", initially suspected to be gallbladder stones, and underwent laparoscopic cholecystectomy after completing the relevant investigations, and was diagnosed with primary cystic echinococcosis of the gallbladder based on the pathologic findings in the postoperative period. The patient recovered well after surgery and remained well without complications during the 6-month follow-up period. This case illustrates that echinococcus granulosus can also parasitize in the gallbladder only, although it is quite uncommon. In addition, it is difficult to distinguish it from gallbladder stones by conventional imaging. The diagnosis of some cases of gallbladder cystic echinococcosis is completed during surgery and confirmed by postoperative pathological results.

Gallbladder Hydatid Disease Complicated with Multiple Hepatobiliopancreatic Fistulae: A Case Report

Gallbladder is a rare localization for hydatid disease. Complications are even rarer and precise diagnosis is quite difficult even with radiological assistance. We report a rare case of 41-yr-old male patient presenting with the rupture of a gallbladder hydatid cyst with multiple fistulae to intra and extrahepatic bile ducts and pancreas, at Kocaeli State Hospital, Turkey in 2021. The patient had abdominal pain and abdominal CT scan reported a bizarre "contrast enhanced cholangiography" sign - radiopaque contrast substance in gallbladder, intra and extrahepatic bile ducts and pancreatic ducts, with concomitant acute cholecystitis. Surgery was performed and intraoperatively gallbladder hydatid cyst with multiple fistulae was noted. Cholecystectomy with total cyst excision was performed. Endoscopic retrograde cholangio pancreatography (ERCP) was utilized to irrigate and eradicate the parasite in the fistulae tracts localized near pancreas and intra/extrahepatic ducts. Postoperative period was uneventful, antiparasitic treatment was started, and in the yearly follow-up patient had no recurrence. Multidisciplinary and minimal invasive management is crucial in such bizarre, complicated cases.

Laparoscopic management of a primary gallbladder hydatid cyst with daughter cysts in the common bile duct: Case report

Introduction and importance

Primary Gallbladder hydatid cysts are a very rare phenomenon caused by Echinococcus granulosus. Hydatid cysts usually present as hepatic or pulmonary lesions, but in our case, it presented in the gallbladder with three symptomatic daughter cysts in the CBD. Echinococcus caused by E.granulosus Is the most common parasite causing the disease, accounting for 95% of the cases.

Case presentation

75 - year - old male presented with colic pain, jaundice, itching, vomiting, nausea, insomnia, Positive murphy's sign, and elevated AST and ALT. Total bilirubin was also elevated with no hepatomegaly or splenomegaly.

Clinical discussion

This disease is endemic in Mediterranean countries due to high contact with the host of the parasite the lumen or on the external surface of the gallbladder. Which can come from the portal system or the spreading of brood capsules through the biliary tract.

Conclusion

The method of investigation used was USG, CT, ERCP which are affordable and accessible in low-income countries including Syria. we would like to highlight this rare presentation and the possibility of using laparoscopic surgery.

•

Primary hydatid cyst is usually found in the liver, lungs and brain in our case it presented in the gallbladder and common bile duct which is very rare.

•

We can encounter primary hydatid cyst in unexpected organs especially in countries with high prevalence.

•

Jaundice in our case was the main presenting symptom.

•

The role of laparoscopic surgery in treatment because of its less invasive nature and the low spillage possibility. This is the second case treated via laparoscopic surgery.

An unusual localization of echinococcosis: Gallbladder hydatid cyst

Echinococcosis is endemic in Mediterranean countries. Liver then lungs are the most affected organs. Gallbladder hydatid cyst is an exceptional localization.

A 64-year-old patient was referred to our surgical outpatient department by his physician for suspicion of liver hydatid cyst based on right upper quadrant abdominal pain, associated with nausea. Physical examination showed mild tenderness of the right upper quadrant of the abdomen. A computed tomography abdominal scan showed a multivesicular cystic lesion of the segment IV measuring 9.5 × 7.5 × 13 cm with exophytic component abutting the gallbladder.

The patient underwent right subcostal laparotomy. The exploration has found that the hydatid cyst is developed from the fundus of the gallbladder, without any connections or fistulas to nearby organs. A cholecystectomy was performed. Histopathological examination confirmed the diagnosis of gallbladder echinococcosis.

Primary gallbladder hydatid cysts (PGHC) is an extremely rare condition, occurring in less than 0.4% of echinococcosis localizations. After literature research of case reports, only twenty-three such cases, including our case, have been reported in English literature. Due to its uncommon nature, radiologists rarely consider a PHGB as the first diagnosis. Preoperative diagnosis of hydatid cyst was possible only in 50% of cases. Therefore, a careful attention is necessary to assist in making the diagnosis preoperatively, leading to the appropriate treatment.

Multiseptate gallbladder: A case report and literature review

RATIONALE

Multiseptate gallbladder (MSG) is a rare congenital gallbladder anomaly. Between 1963 and June 2021, only 56 cases were reported. There is currently no treatment guideline for pediatric or adult cases of MSG.

PATIENT CONCERNS

A 14-year-old woman visited our out-patient clinic in September 2020 for epigastric pain that last for 6 months. Honeycomb appearance of the gallbladder was noted under ultrasonography.

DIAGNOSIS

The patient was diagnosed with MSG. The diagnosis was confirmed through computed tomography and magnetic resonance cholangiopancreatography.

INTERVENTIONS

Cholecystectomy was performed.

OUTCOMES

Epigastric pain showed limited improvement after the surgery. Since she was diagnosed with gastritis at the same time, a proton-pump inhibitor was prescribed. Epigastric pain was eventually resolved.

LESSONS

MSG cases can undergo cholecystectomy and show good recovery without complications. However, concomitant treatment may be required to resolve in the presence of other symptoms such as epigastric pain.