Medical treatment of pulmonary hydatidosis: complications and surgical management

Abstract

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.

Pulmonary hydatid disease in children: outcome of surgical treatment combined with perioperative albendazole therapy

“…After the parasite is killed by chemotherapy, the remaining contents may lead to infection through bronchial communication. In one such series of 36 medically treated children, 31% developed either pleural empyema or pulmonary abscess which required surgical intervention with an even more complicated postoperative course [22]. It is our opinion that medical treatment should not be routinely employed in pulmonary disease because of controversies and inconsistencies of the reported results [22,23].…”

Experience with video-assisted thoracoscopic removal of pulmonary hydatid cysts in children

“…Most of the cases in our series were diagnosed preoperatively based on clinical and radiologic findings and received oral albendazole, 10 mg/kg per day, soon after diagnosis (except case 4, in whom preoperative differential diagnosis was lung abscess and bronchogenic cyst). In all patients, albendazole was continued postoperatively for 6 weeks [3]. The average duration of procedure was 150 minutes, and average length of hospital stay was 4.5 days except in case 2, which was discharged on day 15 because of prolonged air leak.…”

Primary pulmonary hydatid cysts in children—a report of three cases

“…We started oral albendazole 10 mg/kg/day soon after diagnosis and continued it postoperatively for 6 weeks. Although albendazole therapy has been effective in small and young pulmonary hydatids, the complication rate of failed medical management is very high, particularly in cysts more than 6 cm in size [2]; these complications include infective processes such as empyema and lung abscess and also bronchopleural fistula following incomplete expectoration of dead cyst contents. Surgery for complications after medical management increases morbidity significantly [3].…”