Background: Surgical management is considered one of the effective treatment modality for liver hydatid. However the choice of surgery is debatable. This study aims to compare the outcome of radical surgery (RS) and conservative surgery (CS) in liver hydatid disease.Methods: This is retrospective analysis of prospectively maintained institutional data of surgically treated liver hydatid from January 2012 to January 2019. The basis of diagnosis was typical imaging, confirmatory Hydatid serology and/or Intraoperative details. The clinical presentation, radiological data, operative detail, post-operative outcome, post-operative recurrence data was analysed.Results: Sixty-four patients underwent surgery during the study period and were included. RS was done in 27 (42.2%) patients and CS in 37 (57.8%) patients. The mean age was 35.6 (13-72) years. The mean size of the cyst was 10.3 ± 2.9 cm. The cyst location was peripheral in 81.5% and 56.8% in RS and CS groups respectively. Intraoperative Cyst biliary communication was detected in 48.1% of RS & 35.1% in CS group of patients. The post-operative bile leak was significantly less in RS group (7.4% vs 27.0%, p = 0.047). Postoperative endoscopic stenting for persistent biliary fistula was necessitated in five of CS and only one patient from RS group. None of RS patients had recurrence while 3 patients of CS developed recurrence. Conclusion:Radical surgery reduces post-operative bile leak and prevents recurrence and may be preferable to conservative surgery.
Splenic cysts are classified on the basis of epithelial lining, either primary or secondary. Primary cysts are further divided as parasitic and nonparasitic. The secondary cysts are usually post traumatic or after a splenic extension of pancreatic pseudocyst. However, not all pseudocysts are associated with trauma. Mostly, they are asymptomatic (30%-60%) and usually grow in size to cause compressive symptoms. Splenic pseudocysts should be differentiated with other malignant and nonmalignant pathology, specifically hydatid cysts, in order to manage them correctly. The walls of pseudocysts may be degenerative or calcified, which may resemble hydatid cysts. Here, we present a case of a non-traumatic splenic cyst masquerading as a hydatid cyst preoperatively. The patient was taken up for surgery and intraoperatively noted to be a hemorrhagic cyst with a non-splenic cyst wall. We decided to preserve the spleen with marsupialisation of cyst and omentoplasty. On histopathology, the diagnosis of a pseudocyst of spleen was made in view of absent epithelial lining. We would like to report this case because of the diagnostic dilemma, its clinical rarity and, even more, in the absence of any history of trauma.
An angiomatoid fibrous histiocytoma is a rare soft tissue neoplasm of intermediate biologic potential, is often misdiagnosed because of its clinical and radiological similarity to other conditions. Surgery is the mainstay of management and can effectively control local recurrence and metastasis if properly evaluated preoperatively.
Splenic cysts are very rare and are either primary or secondary.It is important to differentiate preoperatively with malignancies and hydatid cysts.Management options are either splenectomy or spleen preserving.We present this case because of its clinical rarity, diagnostic dilemma and histopathological diagnosis of pseudocyst in the absence of trauma.
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