It is difficult to diagnose extrahepatic echinococcosis as it usually is not suspected. Symptoms are related to size, location or ensuing complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area.

Background/Aim:Hydatidosis has a worldwide distribution and the liver is the most common organ involved. Hydatid cysts of the liver can be managed either by nonoperative or operative methods. Nonoperative methods include chemotherapy and percutaneous treatment. The study aimed at understanding the effect of albendazole therapy on the viability of protoscoleces and recurrence rate of hydatid disease of the liver.Patients and Methods:The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of 2 years from January 2002 to December 2003, with further follow-up of 5 years. The study included 72 cases in the age group of 17-66 years, comprising 39 males and 33 females. The patients were randomized into two groups of 36 patients each. In group A, patients were directly subjected to surgery, while in group B, patients were administered albendazole for 12 weeks preoperatively, followed by a further postoperative course for 12 weeks.Results:Of patients who received albendazole therapy, no patient had viable cysts at the time of surgery, as compared to 94.45% of the patients who did not receive any preoperative albendazole (P<0.01). In patients who did not receive any albendazole therapy, recurrence rate was 16.66%, while no recurrence was seen in patients who received albendazole therapy (P≤0.05).Conclusion:We conclude that albendazole is an effective adjuvant therapy in the treatment of hydatid liver disease.

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To the editorWe have gone through the letter sent to the editor by our esteemed readers regarding the conservative management of acute appendicitis (AA). We are highly thankful for their valuable suggestions which are well-taken. We also appreciate their concerns and their keen interest in the study. Here, we would like to mention that none of our patients refused to accept the study and none of our patients requested for any change in the line of treatment. Only two patients were excluded from the study because of increasing abdominal pain and generalized peritonitis and subsequent data was discounted.We agree with the view that despite the fact that conservative treatment could be cost-effective, avoiding the unnecessary surgery and associated morbidity and mortality, surgery is still the gold standard for AA. Further, as we have already mentioned in the manuscript, welldesigned randomized controlled trials in a large population are still needed to establish the superiority of antibiotic treatment over surgery in AA.