Hydatid Cyst Disease

Optimal Management of Complex Liver Involvement

Jacob Moore, BA; Varun Gupta, MD; Mohammed Y. Ahmed, MD; Barbu Gociman, MD, PhD

Disclosures

South Med J. 2011;104(3):222-224. 

In This Article

Case Report

A 51-year-old man from the Middle East, who had been living in the US for the past 11 years, was referred to our surgical department after presenting to the emergency room with severe right, upper-quadrant abdominal pain. He was evaluated with a computed tomography (CT) scan of the abdomen, which revealed two large cystic lesions in the liver consistent with hydatid disease caused by Echinococcus granulosus (Fig. 1, A). Serologic testing confirmed the diagnosis, and the patient was started on albendazole. His pain was inadequately controlled medically, and given the imaging characteristics of the cysts, open surgical treatment was offered to the patient. When the cysts were exposed in a field protected with betadine-impregnated lap sponges, aspiration through a large cannula was attempted. This failed, and was followed with simple evacuation of the main cyst (Fig. 2, A). When all of the cyst's contents were removed, a repetitive infusion of 20% saline and then an unroofing of the cyst were performed (Fig. 2, B). The wall of one of the smaller cysts, which showed bile staining, was inspected for the presence of any significant bile leak. No such leak was identified. The omentum was used to obliterate the cystic cavities, and a drain was left in the bed of the bile-stained cyst. The patient had an uneventful postoperative course. The albendazole treatment was continued for six months. The patient was weaned off pain medication, and his drain was removed three weeks postoperatively. A CT scan was performed three months after the procedure. This confirmed the resolution of the disease, the presence of significantly smaller residual cavities buttressed by omentum, and no signs of recurrence (Fig 1, B).

Figure 1.

Computed tomography (CT) scan of the abdomen revealed two large cystic lesions in the liver consistent with hydatid disease caused by Echinococcus granulosus: before (A), and after successful treatment (B).

Figure 2.

Intraoperative photograph demonstrating the thick-walled endocyst and daughter cysts (A), and entire larger cyst contents after evacuation (B).

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