Pulmonary hydatidosis is more frequently encountered in children than in adults. Chemotherapy with oral administration of particular antihelminthic agents (mebendazole and albendazole) has proved to be effective. This treatment, however, may be associated with serious complications that require surgical management. The aim of this study was to define the limitations of medical treatment, the subsequent complications, and their management. During a 16-year period (1985-2001), 36 children with pulmonary hydatidosis (Echinococcus cysticus) were medically treated. Oral antihelminthic agents (mebendazole until 1992 and albendazole thereafter) were given to all these patients. During this treatment, 11 patients developed complications requiring surgical intervention. In seven children, pleural empyema, or the presence of inflammatory residual fluid, was noted. The remaining four developed pulmonary abscess combined with fluid collection within the pleural cavity. In all complicated cases, the mean size of the cysts exceeded 6 cm in diameter at the beginning of medical treatment. At operation, suturing of communicating bronchi was insecure due to inflammation. Postoperatively, three patients had air leakage from the bronchial tree, requiring continuous suction and prolonged hospitalization. One patient presented with pneumothorax 4 months postoperatively and was operated on again. Overall, long-term results were good. We concluded that a) large pulmonary hydatid cysts should not be treated medically, b) incomplete expectoration of the cyst contents after the parasite death may lead to infection through bronchial communication, and c) patients surgically treated for complications following medical treatment are hospitalized twice as long as patients surgically treated in the first place.
A case of isolated Caroli's disease in a 2-year-old female presented as an exophytic cystic mass of the liver. A palpable mass below the right costal margin and displacement of the right colon were the main points of clinical presentation. Preoperatively, sonographic signs of intraluminal vascular tracts were identified. At laparotomy, the mass was found at the inferior border of the right lobe of the liver next to the gallbladder and was easily removed by wedge excision. Intraoperative liver biopsies and histologic findings of the excised lesion confirmed the diagnosis.
Ligation of the splenic artery, combined with splenorrhaphy, was used successfully on eight children with splenic trauma involving major segmental vessels. Evaluation of the collateral arterial network and of its adequacy was done by means of arteriography on four out of the eight patients. Aortographies were carried out on the twentieth day, the first month, the third month, and the fourth month following the ligation. A collateral arterial network, deriving mainly from the short gastric arteries was detected, dyestream disruption and retrograde filling of the artery. No complications after aortography were noted. Findings demonstrate that collateral blood supply develops rapidly and its pattern is rather uniform.
An 8-year-old boy presented with a prostate utricle cyst, measuring 14.7 x 27.8 cm on ultrasonogram ( Fig. 1).An indwelling catheter was placed in the bladder and the patient placed in a knee-chest position. The skin was incised sagittally in the midline from the tip of the coccyx downward up to the posterior anal perimeter. The underlying part of the external sphincter and muscle complex were cut in the midline with an electroknife under guidance of an electrostimulator. The rectum was exposed and pulled laterally to the right side using two rubber slings. The prostatic cyst was revealed and easily dissected free. It was elliptical and measured 8 x 16 cm after needle aspiration of its urine-like content (Fig. 2 ) . The fistulous communication of the cyst with the prostatic urethra was sutureligated and the cyst removed. Haemostasis was meticulous and draining of the operative field was deemed unnecessary. The rectum was released from the slings and replaced. The incised parts of the muscle complex Fig. 1. Transverse ultrasonogram. The bladder and a large fluid collection posterior to the bladder are demonstrated.and external sphincter were stitched and the skin incision closed. The post-operative course was normal. The catheter was retained until the sixth day and the patient was discharged on the eighth day after surgery, having achieved normal micturition. Histological studies of the cyst demonstrated a two-layer wall, consisting of fibrous tissue and transitional epithelium with foci of infection.
CommentExcision of large or symptomatic utricle cysts is recommended. The rarity of the operation and anatomical difficulties in the operative field have led to a variety of surgical approaches, which are not free of complications. These approaches include the suprapubic transvesical or extravesical, transperitoneal, perineal, transurethral and posterior parasacral. The posterior sagittal approach has been widely used in the repair of congenital anorectal malformations [ 11, cloacal, urogenital sinus and postoperative faecal incontinence in children with anorectal 0 1995 British Journal of Urology 397
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