Clear cystic fluid in hepatic hydatidosis does not rule out communication between cysts and the biliary system

Sönmez, Kaan; Karabulut, Ramazan; Türkyılmaz, Zafer; Başaklar, A. Can; Kale, Nuri

doi:10.1007/bf02849896

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…A very interesting study on the histopathology of the pericyst [20] showed the surprisingly constant finding of small areas of fibrinoid necrosis where the fistula is going to develop. Furthermore, the appearance of bile from the drain is very common after 24-48 hours after percutaneous puncture of large diameter hydatid cyst, as the tension inside the cyst diminish as it is quite frequent the development of "late" biliary fistulas after not radical surgery [21].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

JLRDT

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Introduction: Liver echinococcosis is still an endemic disease in Balkans. PAIR is actually considered the safest therapeutically approach for uncomplicated type I and II cysts, while surgery is indicated for type III or complicated cysts. It's commonly believed that radical surgery could be considered the most appropriate treatment for hydrated disease, but with higher risk of morbidity, much more for centrally located cysts, especially in low-resources hospitals.Aim of the study: According with the tendency in western countries and within a training project leaded by Veneto Region -Italy, we started in cooperation with the Division of Surgery of Peja Hospital Kosovo a prospective study to assess the safety and effectiveness of radical surgery also for centrally located cysts, when PAIR was contraindicated. Materials and Methods:From Feb 2006 to Apr 2010, 10 consecutive patients (6 Female, 4 males, mean age 31, 3± 14 yrs, range 8-54) with 16 cysts were treated for echinococcal liver disease in Surgical Division of Peja Hospital, Kosovo. All patients received Albendazole before operation and in the perioperative period. Medical therapy was discontinued the day after operation. One patient had recurrent echinococcal cysts after previous operation of partial cystectomy and T-tube placement in the biliary duct. Patients were classified to have peripherical (n=1) or centrally (n=9) located cysts when at least one of them was in close relationship with the main vascular and biliary structures. Other than laboratory tests, preoperative evaluation included in all patients abdominal ultrasound and CT scan.Results: Nine pts with 15 cysts underwent radical surgery and 1 patient underwent non radical operation (1 subtotal pericystectomy). Four of them had multiple cysts. Mean operative time was 236 min. Mean postoperative stay was 5, 2± 2, 52 days (range 3-10). No intra or postoperative complications were observed after radical surgery. A bile leak that healed spontaneously after 9 days occurred in patient with subtotal pericystectomy. Mean follow-up is longer than 3 years. Discussion: Therapeutic choices for echinococcal liver disease depend from factors related to patient, cyst, availability of resources and physician. Radical surgery is considered the treatment of choice because of complete elimination of the parasite and the residual cavity, minimizing the risk of recurrence. This approach, especially for central cysts, must be balanced with the risk of complications, but it's the preferred one in Centers with expertise in liver surgery and it was possible in 93% of cases in this series. In our experience mean operative time was prolonged because of meticulous dissections of cysts from surrounding tissue and vessels. It was always possible to dissect the main veins from pericystium, while portal triad structures were more often eroded by the cysts and needed to be sutured. Mean follow-up is more than 3 years and no recurrences were observed until now. Conclusion:Open radical surgery can be considered a reliable...

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Section: Discussionmentioning

confidence: 99%

Untitled

2017

JLRDT

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“…Important cautionary measures are the following: (1) perioperative treatment with albendazole and protection of the surgical field with pads soaked with scolicidal agents to prevent secondary CE and relapses; (2) avoidance of scolecidal agents, in case of open surgery, if cystobronchial or cysto-biliary fistulae are observed (the latter by visualization of the fistula, presence of bile-stained cystic fluid, detection of bilirubin in the fluid, or by cholangiography); and (3) appropriate management of the residual cavity (Junghanss et al 2008). Of note, any connection with the biliary system can be visualized only after reduction of the intracystic pressure; hence, the presence of clear fluid does not rule out cysto-biliary fistulae (Sonmez et al 2007). …”

Section: Surgerymentioning

confidence: 98%

Echinococcosis

Tamarozzi

Brunetti

Vuitton

2014

Helminth Infections and Their Impact on Global Public Health

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Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are zoonoses of great medical and veterinary importance, caused by Echinococcus granulosus and E. multilocularis, respectively. The life cycle of these parasites develops between the dog and other canids, which harbor the adult tapeworm in the intestine, and mammal intermediate hosts (including humans as dead-end occasional hosts) where the larval form, or metacestode, develops in different organs.The impact of CE and AE on human health is important, with an estimated 1.2 million people affected and 3.6 million DALYs lost globally for CE and 666,434 DALYs for AE.We describe epidemiology, host's immune response to parasite, clinical manifestations, diagnosis, and treatment of both CE and AE.

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“…In 2 cases in which patients were undergoing hydatid cyst surgery, the cystic fluid appeared to be clear, but after the germinative membranes were removed, a connection with the biliary system could be seen. Endoscopic retrograde cholangiopancreatography may not help to differentiate between them because of suspected communication between the bile duct and the hydatid cyst [ 11 ]. It has been suggested that small areas of fibrinoid necrosis within the fibrous pericyst may be an explanation for this communication [ 12 ].…”

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confidence: 99%