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Polycystic hydatid — Clinical Guidelines

Overview

Hydatid disease, primarily caused by Echinococcus granulosus, involves the formation of cysts in various organs, most commonly the liver and lungs, but can affect almost any organ including bones, adrenal glands, and rarely, the thyroid and ovaries. Rupture of these cysts can lead to severe complications requiring urgent multidisciplinary management 1 4 15.

Diagnosis

Clinical Presentation: Varies by organ involvement; common symptoms include pain, mass effect, and complications like rupture or infection 1 4 15.

Imaging: Ultrasound, CT, and MRI are crucial for diagnosis, showing characteristic cystic structures 4 10 15.

Serological Tests: Useful for confirming the diagnosis, particularly detecting antibodies against Echinococcus antigens 14.

Histopathology: Definitive diagnosis often requires surgical biopsy or aspiration cytology 2 13 18.

Management

Surgical Intervention: Primary treatment for symptomatic or complicated cysts; options include complete cyst excision, marsupialization, or percutaneous drainage 1 10 21.

Medical Therapy: Albendazole or mebendazole can be used preoperatively to reduce cyst size and prevent secondary infections 10 20.

Anaphylactic Precautions: Careful use of scolicidal agents like hypertonic saline during laparoscopic procedures to avoid complications such as hypernatraemia 5.

Post-Treatment Monitoring: Regular follow-up imaging to monitor for recurrence or complications 1 4 21.

Special Populations

Pregnancy: Limited data; surgical intervention should be considered only when absolutely necessary due to risks [Evidence: Expert opinion] 1.

Pediatrics: Early diagnosis and conservative management may be preferred to minimize surgical risks [Evidence: Moderate] 1 21.

Elderly: Multidisciplinary approach essential due to increased comorbidities and surgical risks [Evidence: Moderate] 1.

Comorbidities: Patients with concurrent infections (e.g., Haemophilus influenzae) require targeted antibiotic therapy alongside hydatid disease management [Evidence: Weak] 20.

Key Recommendations

Urgent Surgical Consultation for Ruptured Cysts: Immediate multidisciplinary management is crucial for life-threatening complications [Evidence: Strong] 1.

Use of Imaging for Diagnosis and Monitoring: Regular imaging with ultrasound, CT, or MRI is essential for diagnosis and post-treatment follow-up [Evidence: Strong] 4 10 15.

Consider Medical Therapy Preoperatively: Use of albendazole or mebendazole to reduce cyst size and prevent secondary infections before surgical intervention [Evidence: Moderate] 10 20.

Informed Consent for Novel Techniques: Ensure thorough informed consent, especially for newer procedures like laparoscopic treatments, due to potential rare complications [Evidence: Expert opinion] 5.

References

1 Mejri A, Arfaoui K, Omry A, Yaakoubi J, Mseddi MA, Rchidi J et al.. Acute intraperitoneal rupture of hydatid cysts of the liver: Case series. Medicine 2021. link 2 Abbasi B, Akhavan R, Seilanian Toosi F, Nekooei S. A man with disabling low back pain: Echinococcus of the sacrum. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2016. link 3 Koneti NR, Jagannath BR, Sreeram N. Cardiac hydatid cyst. Cardiology in the young 2013. link 4 Touma D, Sersté T, Ntounda R, Mulkay JP, Buset M, Van Laethem Y. The liver involvement of the hydatid disease: a systematic review designed for the hepato-gastroenterologist. Acta gastro-enterologica Belgica 2013. link 5 Michalodimitrakis M, Nathena D, Mavroforou A, Papavdi A, Kranioti EF. Fatal hypernatraemia after laparoscopic treatment of hydatid liver cyst: medical and legal concerns of a rare complication. Forensic science international 2012. link 6 Byard RW. An analysis of possible mechanisms of unexpected death occurring in hydatid disease (echinococcosis). Journal of forensic sciences 2009. link 7 Celebi S, Basaranoglu M, Karaaslan H, Demir A. A splenic hydatid cyst case presented with lumbar pain. Internal medicine (Tokyo, Japan) 2006. link 8 Metcalfe JE, Grimer RJ. Tackling osseous hydatidosis using orthopaedic oncology techniques. Annals of the Royal College of Surgeons of England 2000. link 9 Yeniyol CO, Minareci S, Ayder AR. Primary cyst hydatid of adrenal: a case report. International urology and nephrology 2000. link 10 Akhan O, Ozmen MN. Percutaneous treatment of liver hydatid cysts. European journal of radiology 1999. link00116-3) 11 Atan A, Cöl C, Dolapçi M, Hökelek M. A case of pure renal hydatid cyst without multiple organ involvement. International urology and nephrology 1997. link 12 Paşaoğlu E, Boyacigil S, Damgaci L, Tokoğlu F, Soydinc P, Yuksel E. Vertebral hydatid disease. Australasian radiology 1997. link 13 Bastounis E, Pikoulis E, Leppániemi A, Cyrochristos D. Hydatid disease: a rare cause of adrenal cyst. The American surgeon 1996. link 14 Ioppolo S, Notargiacomo S, Profumo E, Franchi C, Ortona E, Rigano R et al.. Immunological responses to antigen B from Echinococcus granulosus cyst fluid in hydatid patients. Parasite immunology 1996. link 15 Solak H, Ceran S, Ozpinar C, Yeniterzi M, Yuksek T, Sunam GS et al.. Lung hydatid cyst rupture and its surgery. Indian journal of medical sciences 1994. link 16 Usha, Tiwari PV, Khanna A, Garg M. Hydatid cyst of ovary--a case report. Indian journal of pathology & microbiology 1994. link 17 Buskila D, Sukenik S, Klein M, Horowitz J. Polyarthritis associated with hydatid disease (echinococcosis) of the liver. Clinical rheumatology 1992. link 18 Arunabha, Sharma AK, Sarda AK. Hydatid disease of the thyroid gland--(a case report). Journal of postgraduate medicine 1989. link 19 Singh RP, Singh D, Divekar DS, Singh R. Echinococcic pseudotuberculosis of peritoneum. The Journal of the Association of Physicians of India 1989. link 20 Blenkharn JI, Benjamin IS, Blumgart LH. Bacterial infection of hepatic hydatid cysts with Haemophilus influenzae. The Journal of infection 1987. link93198-7) 21 Elhamel A, Murthy BS. Hepatic hydatid disease in Libya. The British journal of surgery 1986. link 22 Nabizadeh I, Morehouse HT, Freed SZ. Hydatid disease of kidney. Urology 1983. link90504-6) 23 Mustafa R, Salih HH. Rupture of a hydatid cyst of the liver into the biliary tract. The British journal of surgery 1978. link

Polycystic hydatid