| Home > Table
of Contents >
Case Reports |
| |
Hydatid Cyst of Liver — A Laparoscopic
Management
Amit Goel*, Brijendra Tiwari**, Pavitra Ganguli*** |
| |
| Introduction |
Hydatid cyst is a parasitic disease caused
by Echinococcus granulosus known as classic hydatid disease.
Echinococcus multilocularis results in alveolar hydatid disease,
a less localised disease and both are continuing public health
problem in state of Jammu and Kashmir where sheep herding
and breeding is a widespread profession. We present a case
report of hydatid disease of liver managed laparoscopically
with good results.
|
| |
| Case Report |
| A 32 year male was admitted in our hospital with
pain right hypochondrium since 6 months. There was no history
of weight loss, fever, urticaria. On examination there was
fullness of epigastrium and right hypochondrium. Liver was
palpable two fingers at midclavicular line. There was no icterus,
rashes and oedema. All routine haematological investigations
were normal. Plain film radiography of chest showed a raised
right dome of diaphragm. AntiEchinococcus IgG antibodies was
37 u/l [positive 12 u/l]. Ultrasound showed echogenic mass
of 9 x 9 cm with multiple daughter cysts and clear fluid.Computed
Tomography showed a well defined hypodense lesion of 9 x 9
cm at right lobe of liver with multiple areas of increased
densities with no calcifications. Preoperatively patient was
put on albendazole 10 mg/kg/day for 10 days. Patient was posted
for surgery and laparoscopic cystectomy was planned. Patient
was put in supine position with head raised and left lateral
tilt. A specially designed port [12 mm] having 15 inches length
with a long sheath which reaches into deep seated cavity was
used. It has a side channel of same diameter through which
a strong suction was done and entire contents of cyst were
evacuated. Patient recovered well postoperatively and had no
recurrence of symptoms over a follow up of one year. |
 |
Fig. 1 : MRI chest and neck (Horizontal Section). Arrow Head
: Tumour mass compressing the trachea and oesophagus |
| |
| Discussion |
Echinococcus is present in the intestine of
carnivore like dog which is the definitive host. Eggs are
ingested by herbivore like sheep which is intermediate host
and goes to liver through portal vein where it forms hydatid
cyst. Man is an accidental host. Most common sites are liver
(60%) and lung (30%). Pain in right upper abdomen is the
most common symptom. Specificity of ultrasound is 90% and
CT scan is 100%. Modes of management have been medical with
mebendazole and albendazole. Surgery for hydatid cyst of
liver are percutaneous aspiration, marsupilization, partial
or total pericystectomy and liver resections. Akin et al
concluded in his study that surgical management of hydatid
disease without drainage decreases postoperative complication
rate and average hospitalization period.1
Demirbilk et al studied and compared the results of medical treatment
and various surgical treatment between 1988 and 1997 and concluded that
surgical treatment offers early cure than medical treatment.2
Laparoscopic surgery has added new dimension to hydatid cyst surgery.
Patients with small size and early stage cysts are ideal cases for laparoscopic
treatment as wall collapses after laparoscopic evacuation.
Ertem et al studied 12 patients of hydatid cyst of liver and treated
them laparoscopically and concluded that these patients had postoperative
comfort, less pain, better scar, decreased hospital stay and early return
to daily activities.3
|
|
Fig. 2 : MRI Chest and Neck (Sagittal Section). Arrow head
: Tumour mass in cervical region and superior mediastinum.
anterior mediastinum has no thymic tissue |
| |
| Conclusion |
| Laparoscopic management is an alternative and
useful method of treating hydatid cyst of liver. It has results
comparable with open surgery and has all benefits of minimal
access surgery and is the current treatment of choice for early
management of hydatid cyst of liver. |
| |
| References |
| 1. |
Akin ML, Erenoglu C, Uncu
EU, Basekim C, Batkin A. Surgical management of hydatid
disease of liver- A military experience. J R Arm Corps
1998; 144 (3) : 139-43. |
| 2. |
Demirbilek S, Sander S, Atayvrt HF, Ayding
G. Hydatid disease of liver in childhood; the success
of medical therapy and surgical alternatives. Paediatr
Surg Int 2001; 17 (56) : 373-77. |
| 3. |
Ertem M, Uras C, Karahasanglu T, Erguney
S, Alemdaroglu K. Laparoscopic aproach to hepatic hydatid
disease. Dig Surg 1998; 15 (4) : 333-36 |
| 4. |
Croese TJ. Eosinophilic enteritis-a recent
North Queensland experience. Aust N Z J Med 1998; 18
(7); 848-53. |
| 5. |
Wing-harkins DL, Dellinger GW, Lynch C,
Mihas AA. Eosinophilic gastroenteritis associated with
protein losing enteropathy. J Int Med Res 1996; 24 (1)
: 155-63. |
| 6. |
Wig JD, Goenka MK, Bhasin DK, Vajphei
K. Eosinophilic gastroenteritis presenting as acute intestinal
obstruction. Indian J Gastroenterol 1995; 14 : 104-5. |
| 7. |
Alexander P, Jacob S, Paul V. Laparoscopy
in eosinophilic jejunitis presenting as subacute bowel
obstruction: a case report. Tropical Gastroenterology
2003; 24 : 97-98. |
| 8. |
Kamal MF, Shaker K, Jaser N, Leimoon BA.
Eosinophilic gastroenteritis with no peripheral eosinophilia.
Ann Chir Gynaecol 1995; 98-100. |
| 9. |
Klien NC, Hargrove RL, Sleisenger MH.
Eosinophilic gastroenteritis. Medicine 1970; 49 : 299-319. |
|
|
| |
Eradicating H. pylori
Does not increase symptoms of gastro-oesophageal
reflux disease
Does eradication of Helicobacter pylori lead to an increase
in symptoms of gastro-oesophageal reflux disease? We need
to know this because the benefits of eradicating H. pylori
relative to acid suppression alone are small in non-ulcer
dyspepsia and uninvestigated dyspepsia.
Overwhelming evidence now shows that eradicating H. pylori has little
or no impact on gastro-oesophageal reflux disease in the general population.
BMJ, 2004; 328 : 1388.
|
|
|
