Coexistence of duodenum derived aggressive fibromatosis and paraduodenal hydatid cyst: A case report and review of literature

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study

BACKGROUND

Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD.

AIM

To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.

METHODS

From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.

RESULTS

There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively.

CONCLUSION

Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

Large desmoid tumour of the small bowel mesentery

A 74-year-old man was being investigated for a pancreatic insulinoma when an incidental mesenteric mass measuring 2.6 cm x 2.5 cm was noticed on CT imaging. A wait-and-see approach was decided on. Thirty-nine months later, the patient presented with symptoms of abdominal obstruction. CT images revealed the mesenteric mass filled majority of the abdominal cavity and measured 29 cm x 26 cm x 16 cm. The patient underwent an open bypass gastrojejunostomy which stopped working a few weeks later due to further compression by the tumour. A debulking surgery was performed: a right hemicolectomy and small bowel resection with excision of the desmoid tumour and bypass gastrojejunostomy. The tumour measured 12.6 kg and was macroscopically visualised to have a white cut surface with a focal translucent area. Microscopic analysis revealed bland spindle cells with pale eosinophilic cytoplasm showing no cytological atypia, in keeping with a mesenteric desmoid tumour. Currently, two and a half years from the debulking surgery, the patient remains well and in remission with planned surveillance.

Surgical management of a hepatic hydatid cyst fistulized into the duodenum: A case report

Introduction and importance

Hydatid cyst of liver is a disease usually seen in endemic regions. Fistulization into duodenum is one of the most exceptional complications of the hydatid cyst commonly discovered during surgery. This paper aims to present and discuss a rare case of cyst ruptured into the duodenum. This case report has been reported in line with the SCARE criteria 2020.

Case presentation

A 44-year-old female patient, previously diagnosed with hydatid cyst of liver with deferred care due to the period of COVID 19 containment, presented with the complaints of abdominal pain and fever. Abdominal CT scan showed up a 2 cm multiseptal hydatid cyst in the segment III of the liver with an exovesiculation of 20 cm, communicating with the first duodenum. The patient underwent antrectomy involving the first duodenum and removing the cystoduodenal fistula with a Roux-en-Y anastomosis. She was discharged with full recovery on the postoperative 5th day.

Clinical discussion

Clinical features of hydatid cyst fistulized into the duodenum are non-specific. There are two pathognomonic symptoms, hydatidemesis and hydatidenteria.Typically, cysto-duodenal fistula is intra-operatively discovered. The CT scan is the most used morphological examination. The presence of air in the cyst should alert for the gastrointestinal fistula formation. Surgical strategies to perform should be tailored to every patient and to intra operative findings. The post-operative morbidity and mortality are underestimated in the literature.

Conclusion

The fistulization of Hydatid cyst into the duodenum should be evoked in front of any acute abdominal pain whether or not associated with hydatidemesis or hydatidenteria.

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Hepatic hydatid cyst fistulized in the duodenum is a potentially fatal condition with non-specific clinical features.

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Hydatidemesis and hydatidosis are the two pathognomonic symptoms.

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Fistulized hydatid cyst in the duodenum is often infected and requires urgent surgical management.

Desmoid-type Fibromatosis of the Splenic Hilum: A Rare Tumor at an Unusual Location

Desmoid-type fibromatoses (DTFs), also known as desmoid tumors, are benign but infiltrative neoplasms that often appear next to previous surgical site. Intra-abdominal tumors usually involve the mesentery, but splenic hilum is an unusual localization. We present a case of a desmoid tumor of the splenic hilum laparoscopically resected in a 70-year-old male with a previous history of chromophobe renal cell carcinoma and ocular spindle melanoma. Although benign, desmoid tumors might be infiltrative and produce serious complications. Treatment remains controversial, ranging from surgery and medical therapies to observation. Management of DTF must be individualized, considering the risk of complications and recurrence.

Hydatidosis and the duodenum: A systematic review of the literature

BACKGROUND

Injury to the duodenum (fistula formation, compression, or other complications) by a hydatid cyst (HC) is an exceptional complication.

AIM

To perform a systematic review of the literature on the fistulization of HC in the duodenum.

METHODS

Following PRISMA guidelines, a search for HC with duodenal involvement was carried out in the databases of PubMed, SCielo and EMBASE without time limits.

RESULTS

Fourteen patients were identified, seven men and seven women, with a mean age of 53.14 years (SD = 17.65, range: 28-78). Three out of the 14 (21%) had HC relapse. The most frequent clinical manifestations were abdominal pain and nausea and/or vomiting. Various imaging studies were performed in almost all cases, the most commonly used being abdominal computed tomography (10/14, 71%). A range of surgical techniques were reported, most frequently HC drainage (41%) and enucleations (16%). Ten of the 14 patients had no complications and one patient died. The follow-up period and recurrences could not be determined.

CONCLUSION

The most frequent symptoms were abdominal pain, nausea and vomiting. Computed tomography was the most used diagnostic imaging technique, and HC drainage and fistula closure via laparotomy was the most frequent treatment. However, all diagnostic and therapeutic options for HC fistulizing the duodenum had a low level of evidence.