CASE REPORT
CASE SERIES REPORT: 3 CASES OF USUAL AND UNSUAL
PRESENTATION OF HYDATID DISEASE
Sitaram Gothwal, Ashok Kumar, Sanjay Sharma, Mohit Sharma, Pradeep Gupta.
1.
2.
3.
4.
5.
Professor. Department of General Surgery, SP Medical College, Bikanar, Rajasthan, India.
Assistant Professor. Department of General Surgery, SP Medical College, Bikanar, Rajasthan, India.
Assistant Professor. Department of General Surgery, SP Medical College, Bikanar, Rajasthan, India.
Post Graduate Resident. Department of General Surgery, SP Medical College, Bikanar, Rajasthan, India.
Post Graduate. Department of General Surgery, SP Medical College, Bikanar, Rajasthan, India.
CORRESPONDING AUTHOR:
Dr. Ashok Kumar,
II/11.Nagnechiji Road, I/F
S. P. Medical College Ground,
Bikanar, Rajasthan.
E-mail: drashokraj1@yahoo.co.in
ABSTRACT: Hydatid disease (HD) is a zoonotic infection caused by Echinococcus granulosus
and rarely by Echinococcus multilocularis. The disease is often manifested by slowly growing
cystic masses and continues to be a significant health problem in many sheep-and cattle-raising
areas [1]. Although the liver (75%) and lung (15%) are the most commonly involved organs, the
disease can be seen anywhere in the body (10%) [2,3]. Hydatid disease (Echinococcus
granuloma) is endemic in the middle east and other parts of the world, including India, Africa,
South America, New Zealand, Australia, Turkey and South Europe [4-6].
The incidence of splenic involvement has been reported to be from 0.9% to 8% [1].
Primary splenic hydatidosis is quite rare and accounts for less than 2% [7]. It develops
secondary to systemic dissemination or intraperitoneal spread from ruptured liver hydatid
cysts.
Here we are presenting a case series of 3 cases of hepatic and extra hepatic hydatid
disease treated in our hospital successfully. Clinical symptoms in patients with hepatic locations
of the disease included abdominal pain localized in the epigastrium or right upper quadrant of
the abdomen, tenderness, hepatomegaly with palpable abdominal mass, jaundice, fever.
Symptoms and surgical treatment for extrahepatic cysts varied according to the location of the
cyst. All the patients were treated surgically.
KEYWORDS: hydatid cyst, extrahepatic hydatid disease, hydatid disease
INTRODUCTION: Hydatid disease is a parasite infection caused by the larval stage of the
cestode. Echinococcus granulosus. It is endemic in many parts of the world, including India.
Most frequently it affects the liver and lung. Involvement of spleen is uncommon, representing
less than 2% to 3.5% of all human infestation by Echinococcus.
CASE REPORT:
1.
A 38 years female farmer presented with dull aching pain and gradually increasing Lump
in Right Hypochondrium, Epigastrium, Left Hypochondrium and Left Lumber region over
11/2 years. There was history of Anorexia, weight loss and anemia. Examination revealed
the multiple swelling in abdomen. Hepatosplenomegaly was present. Both liver and spleen
were having irregular surface with multiple non-tender mass palpable over the surface.
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CASE REPORT
2.
3.
On laboratory investigations revealed hemogram decrease Hb (8 gm%), mild increase in
the Eosinophils counts (3%) and raised ESR 40 mm at the end of 1 hour. Liver function
and Renal functions were normal, ultra-sound examination showed 7.5 x 8 cm cystic SOL
with Internal membrane in postero-superior part of Right Lobe of liver and spleen
enlarged up-to umbilicus. Two cystic SOLS internal membrane size 10 x 9.8 cm and 9.1 x 7
cm in spleen. CECT scan of abdomen revealed multiple, well defined cystic lesion-in the
abdomen. In the cysts multiple septation suggestive of Hydatid disease. Patient was
started on Albendazole 400mg b.d. per oral and prepare for surgery. Abdomen was
opened with bilateral subcostal incisions. Splenectomy and excision of cyst from Right
lobe of liver done. Peritoneal cavity thoroughly washed with Povidine iodine and normal
saline. Post operative period was uneventful, oral Albendazole 400 mg b.d. started from
5th post operative day and was continued. Patient was discharged after 15 days; follow-up
period was uneventful.
A 18 years old female presented with c/o chronic bronchitis on/off from 3 months, dull
aching type pain left upper quadrant on/off 3 months, mild grade fever on/off 3 months.
Also h/o dog bite 15 years back. O/E she was anaemic, marked splenomegaly up-to
umbilicus with hepatomegaly, b/l air entry decreased in both lower lobes of lungs.
LFT/RFT within normal range, ESR 60 , eosinophilia ( 04%). USG abdomen-enlarged
spleen 18.7 cm, 11x10 cm thin walled anechoic cystic lesion at upper pole of spleen,
8.7x6.4 cm thin walled anechoic cystic lesion with internal echo seen in lower pole of right
lung s/o hydatid cyst. CECT revealed –splenic hydatid with b/l lung hydatid cyst.
Albendazole 400 mg b.d. started pre-operatively and patient was prepared for OT. After all
general evaluation patient was operated, left lung cyst was excised by left thoracotomy,
cavity was washed with normal saline and Betadine and splenectomy was done by upper
midline abdominal incision. ICDT and Abdominal drain was put, removed on post
operative 5th day. Histo-pathologic reports confirmed the diagnosis. Post operative
Albendazole started. Post-op recovery was uneventful and discharged Post-op 13th day.
Follow-up also uneventful. This patient is further planned for right thoracotomy.
A 22 years old female presented with c/o chronic bronchitis, dull aching type pain with
heaviness in upper abdomen from 6 month and mild grade fever from last 20 days, h/o
having pet dogs earlier. O/E she was anaemic, marked hepatosplenomegaly, air entry
decreased right lower lobe of lung, LFT mildly raised, ESR-75, USG –enlarged spleen 16.8
cm, thin walled anechoic lesion approx 10x9.5 cm present at upper pole of spleen, right
lung-10x10 cm, liver-13x8 cm, s/o hydatid cyst. CECT confers the USG reports. Treatment
regime was same as in previous case i.e. pt was on Albendazole pre-operatively. She was
operated by right thoracotomy and laparotomy by mid line incision. Splenectomy done
with excision of hepatic and thoracic cyst. ICDT and abdominal drain no. 28 put into
respective cavities and removed on post-op 5th day as in previous cases. HPR confirmed
the diagnosis, post-op recovery was un-eventful. Follow-up also uneventful.
DISCUSSION:
Echinococcus granulosus, which is the causative agent of cystic hydatid disease (or cystic
echinococcosis, CE); and Echinococcus multilocularis, which causes alveolar echinococcosis, AE
[1,2]
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CASE REPORT
The diagnosis of CE is based on the patient's history, clinical findings, haematological and serum
biochemical profiles, and serological testing, which may be negative in 10% to 20% of cases.
Efforts to improve diagnostic accuracy have led to integration of a range of imaging techniques
into the diagnostic armamentarium. The radical surgical removal of the cystic lesion remains
the mainstay of treatment with a high success rate. Chemotherapy, with benzimidazole
compounds has also been used with some success to sterilize the cyst, decrease the chance of
anaphylaxis, and reduce the complications and recurrence rate post-operatively. In recent years,
Interventional radiologists and gastroenterologists have used minimal invasive procedures such
as PAIR (puncture, aspiration, injection, re-aspiration) [8-10] and PEVAC (percutaneous
evacuation of cyst content)[11] for treating hepatic echinococcosis and is indicated for patients
who cannot undergo surgery. The study suggests that treatment of this benign disease should
be the less radical surgical technique combined with pre-and postoperative anthelmintic
administration. The surgical treatment should be combined with careful use of scolicidal fluids.
REFERENCES:
1. Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to
toe. RadioGraphics 2003; 23:475–494; quiz 536–537
2. Engin G, Acunas B, Rozanes I, Acunas G. Hydatid disease with unusual localization. Eur
Radiol 2000; 10:1904–1912
3. Gossios KJ, Kontoyiannis DS, Dascalogiannaki M, Gourtsoyiannis NC . Uncommon
locations of hydatid disease: CT appearances. Eur Radiol 1997; 7:1303–1308
4. Altinors N, Senveli E, Donmez T, et al. Management of problematic intracranial hydatid
cysts. Infection 1995;23:283-7.
5. Brown RA, Millar AJW, Steiner Z, et al. Hydatid cyst of the pancreas: a case report in a
child. Eue J Pediatr Surg 1995;5:121-4.
6. Goel MC, Agarwal MR, Misra A. Percutaneous drainage of renal hydatid cyst: Early
results and follow-up. Br J Urol 1995;75:724-8.
7. Durgun V, Kapan S, Kapan M, Karabicak I, Aydogan F, Goksoy E. Primary splenic
hydatidosis. Dig Surg 2003; 20:38–41
8. Akhan O, Ozmen MN , Dincer A, Sayek I, Gocmen A: Liver hydatid disease: long-term
results of percutaneous treatment. Radiology 1996, 198:259-264.
9. Brunetti E, Filice C, Macpherson C, Meslin F, Vuitton D, et al.: PAIR:
Puncture, Aspiration, Injection, Re-aspiration. An option for the treatment of Cystic
Echinococcosis.
http://whqlibdoc.who.int/hq/2001/WHO_CDS_CSR_APH_2001.6.pdf] webcite WHO/
EMC web site Accessed on January 10, 2007
10. Smego RA Jr, Bhatti S, Khaliq AA, Beg MA: Percutaneous aspiration injectionreaspiration drainage plus albendazole or mebendazole for hepatic cystic
echinococcosis: a meta-analysis. Clin Infect Dis 2003, 37:1073-1083.
11. Schipper HG, Lameris JS, van Delden OM , Rauws EA, 281 Kager PA: Percutaneous
evacuation (PEVAC) of multivesicular echinococcal cysts with or without cystobiliary
fistulas which contain non-drainable material: first results of a modified PAIR method.
Gut 2002, 50:718-723.
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CASE-2
CASE-3
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