title: [Hydatid cysts of the spigelian lobe (segment I) of the liver: clinical and therapeutic particularities].
abstract: OBJECTIVE
  Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities.
  
  
  METHODS
  We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our department from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultrasonography, abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography, and three separate serological techniques: electrosyneresis, hemaglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty, simple drainage, and subtotal pericystectomy.
  
  
  RESULTS
  We treated 44 hydatid cysts of segment I surgically in 10 men and 34 women, with a mean age of 40.6 years. Ten patients (22.7%) had a history of hydatid cysts. Symptoms or complications were noted at admission in 45% of cases. Only five cases (11.4%) required emergency surgery. Surgical examination confirmed vascular compression in 17 cases (38.6%) and a biliary fistula in 17 cases (38.6%). Surgical treatment consisted of deroofing in 37 cases (84,1%), with omentoplasty in 23 (54%), subtotal pericystectomy in 3 and simple drainage in 4. Large biliary fistulas (> 5 mm) were treated with bipolar drainage in 2 cases and internal transfistulary drainage in 3. Some hemorrhaging occurred during surgery in 5 cases, and one cyst ruptured in the peritoneal cavity. Albendazole was prescribed postoperatively for nine patients. There was one intraoperative death, secondary to hemorrhage resulting from erosion of the inferior vena cava. Morbidity was 25%. After a mean follow-up of 32 months, five patients had recurrences in the liver but outside segment I.
  
  
  CONCLUSIONS
  Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications are frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.
authors.affiliation: Service de chirurgie générale, EPS Habib Bourguiba, 3029 Sfax, Tunisie. beyroutimi@yahoo.fr
authors.forename: Mohamed Issam
authors.initials: MI
authors.lastname: Beyrouti
authors.forename: Ramez
authors.initials: R
authors.lastname: Beyrouti
authors.forename: Mahdi
authors.initials: M
authors.lastname: Bouassida
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ben Amar
authors.forename: Foued
authors.initials: F
authors.lastname: Frikha
authors.forename: Khalil
authors.initials: K
authors.lastname: Ben Salah
authors.forename: Bassem
authors.initials: B
authors.lastname: Abid
authors.forename: Ahmed
authors.initials: A
authors.lastname: Guirat
authors.forename: Ali
authors.initials: A
authors.lastname: Ghorbel
authors.forename: Jamel
authors.initials: J
authors.lastname: Mnif
authors.forename: Ali
authors.initials: A
authors.lastname: Ayadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000923:Anticestodal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002758:Cholangiography; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000923:Anticestodal Agents; D015766:Albendazole