title: Cutaneous fistulization of the hydatid disease: A PRISMA-compliant systematic review.
abstract: OBJECTIVE
  To provide an overview of the medical literature on cutaneous fistulization in patients with hydatid disease (HD).
  
  
  METHODS
  According to PRISMA guidelines a literature search was made in PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to cutaneous fistulization of the HD. Keywords used were hydatid disease, hydatid cyst, cutaneous fistulization, cysto-cutaneous fistulization, external rupture, and external fistulization. The literature search included case reports, review articles, original articles, and meeting presentations published until July 2016 without restrictions on language, journal, or country. Articles and abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management, were included in the study, whereas articles with insufficient clinical and demographic data were excluded. We also present a new case of cysto-cutaneous fistulization of a liver hydatid cyst.
  
  
  RESULTS
  The literature review included 38 articles (32 full text, 2 abstracts, and 4 unavailable) on cutaneous fistulization in patients with HD. Among the 38 articles included in the study, 22 were written in English, 13 in French, 1 in German, 1 in Italian, and 1 in Spanish. Forty patients (21 males and 19 females; mean age ± standard deviation, 54.0 ± 21.5 years; range, 7-93 years) were involved in the study. Twenty-four patients had cysto-cutaneous fistulization (Echinococcus granulosus); 10 had cutaneous fistulization (E multilocularis), 3 had cysto-cutaneo-bronchio-biliary fistulization, 2 had cysto-cutaneo-bronchial fistulization; and 1 had cutaneo-bronchial fistulization (E multilocularis). Twenty-nine patients were diagnosed with E granulosis and 11 had E multilocularis detected by clinical, radiological, and/or histopathological examinations.
  
  
  CONCLUSIONS
  Cutaneous fistulization is a rare complication of HD. Complicated HD should be considered in the differential diagnosis of cases presenting with cutaneous fistulization, particularly in regions where HD is endemic.
authors.affiliation: Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya Department of Radiology, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey.
authors.forename: Zeynep Sener
authors.initials: ZS
authors.lastname: Bahce
authors.forename: Sami
authors.initials: S
authors.lastname: Akbulut
authors.forename: Ulas
authors.initials: U
authors.lastname: Aday
authors.forename: Firat
authors.initials: F
authors.lastname: Demircan
authors.forename: Ayhan
authors.initials: A
authors.lastname: Senol
mesh_terms: D015766:Albendazole / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D017577:Cutaneous Fistula / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000469:parasitology*; D003937:Diagnosis, Differential; D004443:Echinococcosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000469:parasitology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012421:Rupture; D014057:Tomography, X-Ray Computed
chemical_list: D000981:Antiprotozoal Agents; D015766:Albendazole