Hydatid Disease of the Liver

Abstract

Background: Echinococcosis also known as hydatid disease is a zoonotic parasitic disease caused by a tapeworm. It has a worldwide distribution. For long, it was thought to be a problem of the poorly sanitized "third world" and not given the importance it deserved. However, its occurrence in countries like Australia and New Zealand and recently in countries in Central Europe has meant that it is included in a WHO list of neglected diseases, has recently been the subject of extensive epidemiological studies, and has been the recipient of increased research funding.

Summary: The diagnosis is still based on clinical presentation in an endemic area corroborated with typical findings on imaging which routinely include ultrasound and CT scan. Serological tests have been used in some centers to support the diagnosis. Treatment depends on the site of involvement and can vary from wait and watch to extensive radical surgical procedures. The common element of all treatments is the addition of albendazole which forms an essential cornerstone of all treatment protocols. Inspite having been used for a fairly long time, there is still no consensus on the dose, duration, and timing of therapy with albendazole.

Key message: Hydatid disease continues to be a significant global health problem inspite of a good understanding of its life cycle and rising standards of public sanitation. Though diagnosis is straightforward and not expensive, treatment can sometimes be complicated. The addition of albendazole to all treatment protocols is an important advance, but firm guidelines on duration of its use are still awaited.

Keywords: Albendazole; Echinococcus granulosis; Multilocularis; Puncture aspiration injection reaspiration.

Fig. 1.

Distribution of E. granulosus and CE worldwide (World Health Organization 2011).

Fig. 2.

Life cycle of Echinococcosis (World Health Organization) [4] (see text for details).

Fig. 3.

Pathoanatomy of a hydatid cyst.

Fig. 4.

Hydatid cyst classification (see text and Table 1 for details).

Fig. 5.

Liver-tissue-preserving endocystectomy. First pivotal steps to prevent spillage and to secure decontamination. The cyst is decompressed via a 12-mm trocar followed by instillation of 20% saline solution, as depicted here, avoiding excess pressure within the cyst. The cloths positioned around the cyst are soaked with 20% saline to shield the abdominal cavity. (Dept. of Surgery, University Medical Center Rostock, Germany).

Fig. 6.

Palanivelu-Hydatid System allows for aspiration of cyst content during minimally invasive surgery [33].