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Hydatid disease

  • Due to infection with the helminth Ecchinococcus granulosa
  • Adult worm is found normally in the dog and sheep intestine
  • Man is an accidental intermediate host
  • Infection seen in Mediterranean areas, Australia and South America
  • Liver is the commonest organ involved
  • Cysts are unilocular, can be up to 20 cm in diameter and may be multiple
  • Daughter cysts may develop
  • 70% develop in the right lobe of the liver
  • Lung, brain and bone can also be infected
  • Pathologically hydatid liver cyst has three distinct layers:
    • Ectocyst - fibrous advential layer due to host response
    • Middle layer - laminated membrane of proteinaceous material
    • Endocyst - inner germinal layer from which the scolices may be detached

Clinical features

  • Clinical presentation is often non-specific and may be asymptomatic
  • 60% have right hypochondrial pain
  • Only 15% become jaundiced
  • Other features include skin rashes, pruritus and allergic reactions
  • Cysts can rupture resulting in bronchobiliary fistula

Investigation

  • 30% of patients have an eosinophilia
  • Diagnosis can be confirmed by indirect haemagglutinin assay
  • Plain abdominal x-ray may show calcification in cyst wall
  • Cyst can be imaged with ultrasound or CT
  • Aspiration should not be performed if hydatid disease is suspected
  • Associated with risk of dissemination of infection or anaphylaxis

CT of a hydatic cyst in the right lobe of the liver

Management

  • Pharmacological treatment is not curative
  • Used as an adjunct to surgery to kill spilled scolices
  • The drugs of choice are albendazole, mebendazole and praziquantel
  • If surgery is required a laparotomy is performed to exclude other cysts
  • The liver is packed off with hypertonic saline-soaked swabs
  • Cysts are then decompressed with trocar and cannula
  • Scolicidal agent (e.g. hypertonic saline or 0.5% silver nitrate) can be injected into cyst cavity
  • Cavity is filled with saline and a suction drain inserted
  • Alternatively liver cysts can be excised

Hydatid cyst

Picture supplied by Dr T Bombardieri, Italy

  • Hepatic resection may be required for recurrent cysts
  • Recurrence rate is approximately 5% at 5 years

Complications

  • Operative mortality is less than 2%
  • Complications include:
    • Subphrenic abscess
    • Prolonged cyst drainage

Bibliography

Ayles H N,  Corbett E L,  Taylor I et al.  A combined medical and surgical approach to hydatid disease:  12 years experience at the Hospital for Tropical Diseases, London.   Ann R Coll Surg Eng 2002;  84:  100-105.

Sayek I,  Onat D.  Diagnosis and treatment of uncomplicated hydatid cyst of the liver.  World J Surg 2001;  25:  21-27.

 

 
 

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