Professional Documents
Culture Documents
Dr Rojan Adhikari
FCPS Resident
General Surgery
Kathmandu Model Hospital
Hydatid cyst
• Echinococcosis (hydatid disease) is a
zoonosis caused by the larval stage of
Echinococcus.
SYMPTOMS Percentage
Asymptomatic 75%
Abdominal pain 20%
Dyspepsia 13 %
Fever and chills 8%
Jaundice 6%
Clinical Presentation
SIGNS
• Right upper quadrant mass
• Right upper quadrant tenderness
Suppuration and Secondary Bacterial Infection
• An enlarging cyst
– atrophy of surrounding hepatocytes
– fibrosis
– compensatory hypertrophy of the remaining liver
parenchyma
– replaces an entire liver lobe
• Serious consequence of cyst enlargement is cyst
Rupture
Ruptue of ectocyst
Unilocular multilocular
Within yellow fluid of gelatin like amorphous mass inside
pericyst
Free Rupture
I. biliary colic
3
• WBC count <10,000/mm - 10%
Investigation
X-ray
• Limited value
(3)management of complications
Anti helmenthics
• Medical therapy for echinococcosis is limited to the
benzimidazoles (mebendazole and albendazole)
• used alone is only 30% successful.
• Albendazole is readily absorbed from the intestine and
metabolized by the liver to an active form.
Mebendazole is poorly absorbed and is inactivated by
the liver.
Combination is used
Contraindicated in pregnancy, cyst communicating to
billary tree and calcified cyst
PAIR technique
Complication of PAIR
• Spillage and anaphylaxis,
• Recurrence
• Mechanical damage to other tissue
• Bilary fistula
• Hemorrhage
• Infection
Surgery
• Surgery is still the treatment of choice for
uncomplicated hydatid disease of the liver.
Conservative
• Marsupialisation
• Capittonage
• Partial Pericystectomy
• Laparoscopic approach
57 articles were selected for final analysis: one meta-analysis, 9
randomized clinical trials, 5 non-randomized comparative prospective
studies, 7 non-comparative prospective studies, and 34 retrospective
studies
Conclusion
• Antihelminthic treatment alone is not the ideal treatment
for liver hydatid cysts.
• More studies in the literature support the effectiveness of
radical treatment compared with conservative treatment.
• Conservative surgery with omentoplasty is effective in
preventing postoperative complications.
• A laparoscopic approach is safe in some situations.
• Percutaneous drainage with albendazole therapy is a safe
and effective alternative treatment for hydatid cysts of the
liver.
• Radical surgery with pre- and post-operative administration
of albendazole is the best treatment option for liver hydatid
cysts due to low recurrence and complication rates.
References
• Mastery of surgery
• UpTodate online
• Parasitology “K D Chatterjee”
Thank you