LIVER HYDATID CYST

CLASSIFICATION OF HYDATID CLASSIFICATION OF HYDATID CYSTSCYSTS

• PRIMARY CYSTS PRIMARY CYSTS

• MULTIVESICULAR OR SECONDARY MULTIVESICULAR OR SECONDARY CYSTSCYSTS

• SECONDARY ABDOMINAL SECONDARY ABDOMINAL IMPLANTATIONIMPLANTATION

Natural history of liver hydatidNatural history of liver hydatid

• 1 - 1 - Development of cyst – biliary Development of cyst – biliary communicationscommunications

• 2 -2 - Intrabiliary ruptureIntrabiliary rupture • 3 3 - Intraabdominal rupture- Intraabdominal rupture

• 4 - 4 - Intrathoracic ruptureIntrathoracic rupture • 5 - 5 - Intrathoracic ruptureIntrathoracic rupture • 6 - 6 - Cyst deathCyst death

CLINICAL FEATURESCLINICAL FEATURES

• 1 – Symptomless 1 – Symptomless

• 2 –Painful or painless hepatomegaly2 –Painful or painless hepatomegaly

• 3- Abdominal mass3- Abdominal mass

• 4-Jaundice 4-Jaundice

• 5 - Intraperitoneal rupture 5 - Intraperitoneal rupture

DIAGNOSTIC STUDIESDIAGNOSTIC STUDIES

• Serological testsSerological tests• Imaging techniquesImaging techniques

1 Ultrasonography1 Ultrasonography

2 CT scan 2 CT scan

3 MRI3 MRI

4 ERCP4 ERCP

TREATMENTTREATMENT

• Medical treatment Medical treatment

bebzimidazole groupbebzimidazole group

PraziquantelPraziquantel

Indications of medical treatmentIndications of medical treatment

1 Inoperable cases 1 Inoperable cases

- Site - Site

- Multiple cysts - Multiple cysts

2 Concomitant diseases2 Concomitant diseases

ContraindicationsContraindications

1 Pregnancy or lactation .1 Pregnancy or lactation .

2 Heavily calcified cysts .2 Heavily calcified cysts .

3 large cysts .3 large cysts .

4 Obstructive jaundice .4 Obstructive jaundice .

Surgical treatmentSurgical treatment

• ObjectivesObjectives

Remove all living cyst elements .Remove all living cyst elements .

Prevent spillage .Prevent spillage .

Close biliary communications .Close biliary communications .

Sterilize cavity .Sterilize cavity .

Scolicidal agentsScolicidal agents

1- Hypertonic saline ( 3 % ) .1- Hypertonic saline ( 3 % ) .

2- Hydrogen peroxide 6% .2- Hydrogen peroxide 6% .

3- Citeramide .3- Citeramide .

4- Silver nitrate 0.5% .4- Silver nitrate 0.5% .

5- Rectified spirit ( 96% ) .5- Rectified spirit ( 96% ) .

6- Formalin 6- Formalin

Intrabiliary ruptureIntrabiliary rupture

• Operative cholangiogram .Operative cholangiogram .

• Bile duct exploration .Bile duct exploration .

• T tube insertion .T tube insertion .• CholedochoscopyCholedochoscopy .

Residual cavity managementResidual cavity management

• (1) Suture any obvious small bile duct (1) Suture any obvious small bile duct openings openings

• (2) Fill it with ordinary 0.9% saline (2) Fill it with ordinary 0.9% saline

• (3) Saucerize it by excising the protruding (3) Saucerize it by excising the protruding portion portion

• (4) Fill it with a graft of omentum. (4) Fill it with a graft of omentum.

• (5) Stitch the walls of the cyst (5) Stitch the walls of the cyst