Treatment strategy for hydatid cysts with multiorgan involvement/localization

Abstract

Hydatid cyst is a parasitic disease commonly observed in developing countries. In this study, 24 patients treated for multiorgan hydatid cyst disease in our clinic between 2001 and 2011 were retrospectively evaluated. Twenty patients had hydatid cysts in lungs and liver; one had cysts in heart, lungs, and liver; one had cysts in heart and lungs; and one had cysts on left diaphragm and liver. Twenty-one patients underwent posterolateral thoracotomy. In two patients, exploration was performed via median sternotomy. During thoracotomy, five cysts located in the right lung and liver were intervened with phrenotomy. Eighteen cysts were excised by using cystotomy plus capitonnage, four by cystotomy plus pericystectomy plus capitonnage, and two by enucleation. Five of the cases were ruptured hydatid cysts. Four of these patients had received 10 mg/kg/day albendazole treatment previously due to hydatid cyst of liver. The mean hospital stay was 17 days for ruptured cysts and 7 days for non-ruptured cysts. Preoperative medical treatment in patients with multiorgan hydatid cyst causes pulmonary cyst rupture, and eventually leads to morbidity. So, it is advisable that before starting medical treatment, the lungs should be screened for hydatid cysts. 

Keywords

• Hydatid disease
• Multiorgan
• Lung
• Rupture

References

1. Athanassiadi, K., Kalavrouziotis, G., Loutsidis, A., Bellenis, I., Exarchos, N., 1998. Surgical treatment of echinococcosis by a transthoracic approach: A review of 85 cases. Eur. J. Cardiothorac. Surg. 14, 134-140.
2. Balik, A.A., Basoglu, M., Celebi, F., Oren, D., Polat, K.Y., Atamanalp, S.S., Akçay, M.N., 1999. Surgical treatment of hydatid disease of the liver: Review of 304 cases. Arch. Surg. 134, 166-169.
3. Bouckaert, M.M., Raubenheimer, E.J., Jacobs, F.J., 2000. Maxillofacial hydatid cysts. Oral. Surg. Oral. Med. O. 89, 338-342.
4. Bozbuga, N., Erentug, V., Akinci, E., Yakut, C., 2003. Is surgical therapy the only treatment of choice for cardiac echinococcossis with multiple organ involvement? Interac. Cardiovasc. Thorac. Surg. 2, 367-368.
5. Burgos, R., Varela, A., Castedo, E., Roda, J., Montero, C.G., Serrano, S., Téllez, G., Ugarte, J., 1999. Pulmonary hydatidosis: Surgical treatment and follow-up of 240 cases. Eur. J. Cardiothorac. Surg. 16, 628-634.
6. Davis, A., Pawlowski, Z.S., Dixon, H., 1986. Multicentre clinical trials of benzimidazole carbamates in human echinococcosis. Bull. WHO. 64, 383-3
7. Dhaliwal, R.S, Kalkat, M.S., 1997. One-stage surgical procedure for bilateral lung and liver hydatid cysts. Ann. Thorac. Surg. 64, 338-341.
8. Diaz-Menendez, M., Pérez-Molina, J.A., Norman, F.F., Pérez-Ayala, A., Monge-Maillo, B., Fuertes, P.Z., López-Vélez, R., 2012. Management and outcome of cardiac and endovascular cystic echinococcosis. PLOS. Negl. Trop. 6, 1437.

9. Dziri, C., Haouet, K., Fingerhut, A., Zaouche, A., 2009. Management of Cystic echinococcosis Complications and Dissemination: Where is the Evidence? World J. Surg. 33, 1266-1273.
10. Engin, B., Acunas¸ B., Rozanes, I., Acunas¸ G., 2000. Hydatid disease with unusual localization. Eur. Radiol. 10, 1904-1912.
11. Guven, A., Sokmen, G., Yuksel, M., Kokoglu, O.F., Koksal, N., Cetinkaya, A., 2004. A case of asymptomatic cardiopericardial hydatid cyst. Jpn. Heart J. 45, 541-545.
12. Harlaftis, N.N., Aletras, H.A., Symbas, P.N., 2005. Hydatid Disease of the Lung. In Shields TW: General Thoracic Surgery. Lippincott Williams Wilkins, Philadelphia. 1298-1308.
13. Hsairi, M., Chahed, M.K., Bchir, A., Dammak, J., Kilani, T., Kebir, A., Kamel, N., Dziri, C., Sidhom, M., 1995. Incidence chirurgicale del’hydatidose en Tunisie Tunisie Chirurgicale. 4, 20-26.
14. Keles, C., Sismanoglu, M., Bozbuga, N., Erdogan, H.B., Akinci, E., Ipek, G.,Yakut, C., 2000. A cardiac hydatid cyst involving the basal interventricularseptum causing biventricular outflow tract obstruction. Thorac. Cardiovasc. Surg. 48, 377-379.
15. Kılıç, Ö., Camcıoğlu, Y., Akçakaya, N., Çokuğraş, H., Ataseven, F., Dashtir, ve ark., 2010. Nadir primer serebral yerleşimli hidatik kist olgusu. Çocuk Enf. Derg. 4, 117-119.
16. Koppen, S., Wejda, B., Dormann, A., Seesko, H., Huchzermeyer, H., Junghanss, T., 2003. Anaphylactic shock caused by rupture of an echinococcal cyst in a 25-year-old asylum seeker from Georgia. Dtsch. Med. Wochenschr. 128, 663-666.
17. Koubâa, M., Lahiani, D., Abid, L., Mâaloul, I., Kahla, S.B., Bradii, M., Marrakchi, C., Hammami, B., Mnif, Z., Mnif, J., Kammoun, S., Jemâa, MB., 2012. Can albendazole be the only treatment for cardiac echinococcosis with multiple organ involvement? Int. J. Cardiol. 161, 58-60.