Surgical management of complicated hydatid disease of the liver.
Increased worldwide travel and immigration have led to an increase in the incidence of hepatic hydatid disease outside of endemic areas. In nonendemic areas lack of familiarity with the disease may lead to a delay in diagnosis with increased risk for development of complicated disease. Complicated disease is defined as: infected cysts, cysts with a hyperechoic solid pattern or calcified walls, or cysts with biliary rupture. Over a 6-month period six patients with complicated hydatid disease were referred to our institution. All six patients were immigrants from endemic areas and were found to have complicated hepatic hydatid disease including cholangitis and intrabiliary rupture. Patients were treated with oral albendazole for 3 weeks before operation and oral praziquantel for 2 days preoperatively. Surgical therapy consisted of subtotal cystectomy, cholecystectomy in all patients, and cystic duct biliary decompression-drainage in five patients. The one patient without biliary drainage developed a postoperative bile leak that resolved with endoscopic biliary stenting. All patients received albendazole for 3 months postoperatively and were free of disease at 6 to 24 months follow-up. We conclude that although nonoperative management with percutaneous drainage or medical management alone may be successful in patients with uncomplicated disease operation remains the therapy of choice for complicated hydatid disease.
Jabbour
Nicolas
N
Division of Hepatobiliary/Pancreatic Surgery and Abdominal Organ Transplantation, University of Southern California, LAC/USC, Los Angeles, California 90033, USA.
Shirazi
Sherin K
SK
Genyk
Yuri
Y
Mateo
Rod
R
Pak
Eddy
E
Cosenza
D Carlos
DC
Peyré
Christian G
CG
Selby
Robert Rick
RR
D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde; D019299:Decompression, Surgical; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D000871:Anthelmintics; D015766:Albendazole