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Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 443-446
Ultrasound guided lap assisted management of hydatid cysts of liver


Consultant Radiologist, Abhishek's Institute Of Imageology, Hyderabad - 33, India

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   Abstract 

Objective : This technique is to manage deep seated hydatid cysts of liver by a guided minimally invasive method. Design : This is an on going prospective case series, three patients have been treated by this method. Out come : Follow up ultrasound scans revealed complete enucleation of hydatic cysts. Result : This technique has higher treatment satisfaction with minimal intervention and morbidity and better compliance due to early recovery. Conclusion : Initial experience with this technique is encouraging in the management of deep seated hydatid cysts of liver.

Keywords: Hydatid, Cysts, Liver

How to cite this article:
Parveen T, Abhishek T. Ultrasound guided lap assisted management of hydatid cysts of liver. Indian J Radiol Imaging 2005;15:443-6

How to cite this URL:
Parveen T, Abhishek T. Ultrasound guided lap assisted management of hydatid cysts of liver. Indian J Radiol Imaging [serial online] 2005 [cited 2020 Oct 20];15:443-6. Available from: https://www.ijri.org/text.asp?2005/15/4/443/28769

   Introduction Top


Hydatid disease is characterized by world wide distribution and frequent hepatic involvement.

Hydatid disease of liver has been treated medically & surgically by laparotomy or laproscopy.

These management modalities were associated with morbidity and were not effective, requiring prolonged periods of medical treatment.

Deep seated hydatid cysts in liver were difficult to manage surgically.

Ultrasound guided lap assisted management of liver hydatid cysts proved very effective in over coming various management limitations.


   Material and methods Top


This technique was used to manage deep seated hydatid cysts in the liver which were not easily amenable by laparotomy (or) laproscopy.

Three patients were diagnosed to have hydatid cysts of the liver by ultrasound examination one patient had the cyst along the superior surface of the liver just abutting the right dome of diaphragm in the segment 8.[Figure - 1]

Second patient had a hydatid cyst diagnosed ultrasonographically in the 6th segment.[Figure - 2].

The third patient had a hydatid cyst in the left lobe of the liver in the 2nd segment.

All these patients clinically presented with mild to moderate discomfort in the right Hypochondrium, hence were sent for ultrasound examination.

Ultrasound examination was done with a 3.5 MHz convex transducer.

Patients were asked to come on empty stomach, whole abdomen ultrasound scan was performed.

Hydatid cyst of liver was diagnosed by features such as :

  1. Cysts having debri due to sand and scolices.
  2. Seperation of the two layers of the wall of hydatid( Floating membrane sign).
  3. Demonstration of daughter cysts ( echinococcus multilocularis).


Location of hydatid cyst were identified

Diagnosis of hydatid cyst was conformed by :

  1. Indirect agglutination test.
  2. Complement fixation test.
  3. Casoni`s skin test.


Laparoscopic Equipment

We used 10 mm trochor, 10 mm 30 scope, halogen light source, 5 mm suction irrigation cannula , a reducer forceps, video camera and T.V. monitor.

Suction apparatus.

18 Gz spinal needle.

Method :

Patient with hydatid cyst in the 8th segment was taken up for laparoscopic management under general anesthesia. After introducing the scope liver surface was visualized. There was no surface bulge or parenchymal change. Before abandoning, ultrasound examination in the theatre was requested. On ultrasound examination the hydatid was found along the superior surface of the liver & was deep seated. It was discussed and was agreed upon introducing a 18 Gz needle under ultrasound guidance in to the cyst through 7th intercostal space between anterior & middle axillary lines. 10 cc of turbid fluid was aspirated. A small incision was made at the needle insertion site, after assessing the depth a 10 mm trochor was introduced through which the scope was introduced directly into the cyst. The intra cystic contents were visualized. scope was removed, a 5 mm suction irrigation canula was introduced through a reducer and was connected to a suction apparatus. By applying suction the cyst contents were completely emptied into the suction jar which had turbid fluid with multiple daughter cysts. The cyst membranes were also detached by the suction and were removed by introducing a forceps. The cavity was flushed with Betadine solution and a drain (Malecots 8F) was left in the cavity and connected to a urosac. The patient was sonographically examined after 24 to 48 hours.[Figure - 3] The drain was removed once the drain became dry after 48 hours. Patient was sent home and was emperically put on Albendazole and was asked to come back for ultrasound exam after 2 weeks. Follow up scan showed complete clearance of hydatid and there was some parenchymal irregularity which got cleared after 8 weeks.[Figure - 4] The same technique was followed in the other two cases with axillary approach for the hydatid cyst located in the sixth segment and epigastric approach for the cyst located in the left lobe 2nd segment.


   Results Top


Ultrasound guided lap assisted management of hydatid cysts of liver was practiced in three patients with deep seated hydatid cysts.

Approach to deep seated hydatid cysts was always a problem This technique helped in managing these cases with much ease.

In all the three cases there was complete clearance. The procedure was associated with minimal tissue trauma hence minimal morbidity. This lead to early recovery in all the three cases. The patients could be sent home early and could get back to work.


   Discussion Top


This is an ideal technique in managing deep seated hydatid cysts.

Hydatid cysts if asymptomatic are usually left alone.

Patient with hydatid cysts can be medically managed by administrating Albendazole for several weeks to 2 years. This method of management of hydatid cysts of liver is associated with prolonged treatment hence poor patient's compliance

Alternatively hydatid cysts can be percutaneously aspirated, scolicidal agents infused and re-aspirated (PAIR). The clearance rate was not encouraging. This was not indicated in superficially located hydatid cyst because of risk of rupture and peritoneal spill. This is also not useful in multilocular cysts as aspiration from each loccule will be difficult.

Surgical management of hydatid cyst can be achieved by

1. Excision of the hydatid vesicles using the natural cleavage plane that exists between the germinative layer and adventitia.

2. Total removal of cyst including the adventitial layer.

3. Partial hepatectomy with controlled hepatic resection has been advised for larger and multiple cysts.

Complications of surgical management

1. Prolonged drainage.

2. Sinus tract formation.

3. Peritoneal contamination.

4. Thoracic contamination.

5. Cysts communicating with biliary dusts may result in exravasation of bile.

Laparoscopic Management

Laparoscopic management requires introduction of multiple ports (three) & Pnemoperitoneum is created.

Deep seated hydatid cysts cannot be identified

Multiple incisions of the liver surface has to be made.

Ultrasound guided lap assisted managements

Ultrasound guided lap assisted management over comes limitations associated with Medical, Pairs, Laparotomy and Laparoscopy.

This is the ideal method in managing deep seated hydatids.

This procedure requires less anesthetic time.

Avoids major surgery

Associated with less tissue trauma.

Involve less hospital stay.

Hence early recovery.

And is very cost effective.[3]

 
   References Top

1.Principles of surgery by Schwartz, Shires, Spencer, Daly, Fischer, Galloway - volume 2, edition-7.  Back to cited text no. 1    
2.Harrison's principals of internal medicine by Braunwald, Faucl, Kasper, Hayser, Lango, Tameson - vol - 1, 15TH edition.  Back to cited text no. 2    
3.Clinical ultrasound a compremensive text edited by Keith c Dewbury Hylton b Meire ; David O Cosgrove & Patfarrant volume 2 ; 2nd edition  Back to cited text no. 3    

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Correspondence Address:
TLN Parveen
Plot No. 740-A, Road No. 37,Jubilee Hills, Hyderabad - 33
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28769

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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    Abstract
    Introduction
    Material and methods
    Results
    Discussion
    References
    Article Figures

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