LIVER HYDATID LIVER HYDATID DISEASE:ETHIOLOGY,DISEASE:ETHIOLOGY,

DIAGNOSTIC & SURGICAL DIAGNOSTIC & SURGICAL TREATMENTTREATMENT

LIVER HYDATID LIVER HYDATID DISEASE:ETHIOLOGY,DISEASE:ETHIOLOGY,

DIAGNOSTIC & SURGICAL DIAGNOSTIC & SURGICAL TREATMENTTREATMENT

prof. prof. Boyukkishi AgayevBoyukkishi AgayevAzerbaijan Medical UniversityAzerbaijan Medical UniversityInstitute of Clinical Medicine,Institute of Clinical Medicine,

BakuBaku

prof. prof. Boyukkishi AgayevBoyukkishi AgayevAzerbaijan Medical UniversityAzerbaijan Medical UniversityInstitute of Clinical Medicine,Institute of Clinical Medicine,

BakuBaku

Echinococcus granulosus adults in situ

Hydatid cysts in bovine liver.

Ways of Contamination:Ways of Contamination:

•Through Gastrointestinal Through Gastrointestinal tract tract

•Through Respiratory tractThrough Respiratory tract

•Through Wound SurfaceThrough Wound Surface

Distribution of patients by age Distribution of patients by age

and sexand sex Years

Sex

< 20 21-30

31-40

41-50

51-60

61-70

>75 Total:

№ %

Male: 18 14 29 22 11 9 2 105 35,2

Female: 16 40 61 30 25 21 __ 193 64,8

Total (number):

34 54 90 52 36 30 2 298 100,0

Total (%) 11,4 18,1 30,2 17,4 12,1 10,1 0,7 100,0

Localization of cysts in liver Localization of cysts in liver lobeslobes

240(80,5%)

18 (6,1%)

Both lobes – 40 (13,4%)

Both lobes40 (13,4%)

STAGES OF DISEASE STAGES OF DISEASE COURSE:COURSE:

• I I Asymptomatic stage (period Asymptomatic stage (period from worm invasion prior to from worm invasion prior to the beginning of clinical the beginning of clinical manifestations)manifestations)

• II II Stage of clinical Stage of clinical manifestationsmanifestations

• III III Stage of complicationsStage of complications

COMPLICATIONS OF LIVER ECHINOCOCCOSIS

Calcination of cysts 8,1%

Suppuration of cysts21,5%

Affection of bile ducts (20,5%)

Perforation into abdominal cavity

(0,3%)

CLASSIFICATION OF BILIARY AFFECTIONS IN LIVER HYDATID DISEASE

(by A.A.Movchun,R.M.Agayev, 2003)

Segmental lesionsLesions of hepatic

ducts

InternalCystobiliary

fistulas

Bilio-bron-chial

fistulas

Rupture into

frank bile ducts

Comp-ression

of hepa-tic

ducts

Cicatricialstrictures

of bileducts

CLINICAL MANIFESTATIONS & CLINICAL MANIFESTATIONS & SIGNS OF LIVER HYDATID SIGNS OF LIVER HYDATID

DISEASEDISEASE• Pain (92,5%)Pain (92,5%)• Weight feeling in right subcostal Weight feeling in right subcostal

region(38,4%)region(38,4%)• Dyspepsia (23,5%)Dyspepsia (23,5%)• Fever (17,8%)Fever (17,8%)• Jaundice and chill (3,5%)Jaundice and chill (3,5%)• Allergic reaction (6,4 %)Allergic reaction (6,4 %)• Hepatomegaly (62,8%)Hepatomegaly (62,8%)• Disssimetry of stomach (4,7%)Disssimetry of stomach (4,7%)

Disssimetry of stomach in patient with Disssimetry of stomach in patient with liver hydatid diseaseliver hydatid disease

A- Calcination of hepatic cyst B- High standing of the right right dome of a diaphragm

X-ray Examination

X-ray Examination

A- High standing of the right B- Calcinated cyst with a level dome of a diaphragm of gas - an attribute of the with exudate in pleura cysto-biliary fistulas

UltrasonographyUltrasonography

Echogram of the liver: multicamerate non-complicated hydatid cyst

ULTRASONOGRAPHYULTRASONOGRAPHY

A – Suppuration of B- Separation ofhydatid cyst cuticular layer

ULTRASONOGRAPHYULTRASONOGRAPHY

A- Calcination of B – rupture of hydatid cyst hydatid cyst with obstruc- tion of choledochus

Bileducts

CT-scanCT-scan

Hydatid cyst in right lobe of liver

CT-scanCT-scan

Suppuration of liver hydatid cyst

CT-scanCT-scan

Calcination of liver hydatid cystsCalcination of liver hydatid cysts

1

2

CT-scanCT-scan

1 & 2 – Hydatid cysts of the liver1 & 2 – Hydatid cysts of the liver3 – dilated bile ducts3 – dilated bile ducts

Nuclear-magnetic resonant Nuclear-magnetic resonant tomographytomography

ERCPERCP

• Dilated bile Dilated bile ducts & ducts & contrasted contrasted cyst’s cavitycyst’s cavity

ERCPERCP

Hydatid cyst Hydatid cyst

rupture into rupture into bile ductsbile ducts

FistulocholangiographyFistulocholangiography

• Two residual Two residual cavitiescavities

with parasite with parasite elements,elements,

which required which required surgicalsurgical

treatmenttreatment

Puncture of cyst (a) & injection Puncture of cyst (a) & injection into cyst cavity antiscolicidal into cyst cavity antiscolicidal

solution (b)solution (b)

a b

Germinativelayer

Gauze withAntisepticsolution

Hydatidcyst

gallbladder

Scheme of apparatus for removing of Scheme of apparatus for removing of hydatid cystshydatid cysts

• 1- accepting capacity; 2 – bent tube; 3-lateral aperture;1- accepting capacity; 2 – bent tube; 3-lateral aperture; 4 – puncture needle; 5 – source of vacuum4 – puncture needle; 5 – source of vacuum

The circuit of application of the device for The circuit of application of the device for drainage of hydatid cystsdrainage of hydatid cysts

• a -a -Removal of Removal of daughter cysts daughter cysts from cyst cavityfrom cyst cavity with the help of with the help of the spoonthe spoon

• B – special B – special dipper for dipper for removal of removal of cysts containscysts contains

Type of operations

Type of operations: Total %

Echinococcectomy with complete liquidation of residual cavity:

84 28,2

Echinococcectomy with suture appliance and external drainage of residual cavity:

154 51,7

Echinococcectomy with external drainage of residual cavity:

29 9,8

Pericystectomy: 26 8,6

Resection of liver: 5 1,7

Total: 298 100

The circuit of echinococcectomy operationThe circuit of echinococcectomy operationwith liquidation & external drainage of with liquidation & external drainage of

residual cavityresidual cavity

a b

c

OmentoplastOmentoplastyy

of residual of residual cavity cavity

gallbladder

Fibrouse capsule

Echinococcectomy with Echinococcectomy with complete liquidation of residual complete liquidation of residual cavitycavity

PericystectomyPericystectomy

PericystectomyPericystectomy

Resection of left lobe of liverResection of left lobe of liver

• a – CT-scan: a – CT-scan: hydatid cysthydatid cyst occupies all left occupies all left lobe of a liverlobe of a liver

• b - Resection of b - Resection of left lobe of a liverleft lobe of a liver

Resection of right lobe of Resection of right lobe of liverliver

• A – CT-scan: A – CT-scan: large hydatid large hydatid cyst in right cyst in right lobe of liverlobe of liver

• B – Circuit of B – Circuit of operationoperation

Circuit of pathology & operation in case of Circuit of pathology & operation in case of rupture of hydatid cyst into bile ductsrupture of hydatid cyst into bile ducts

• A Choledocho-A Choledocho-duodenostomyduodenostomy

• Choledocho-Choledocho-jejunostomyjejunostomy

a

b

• A - hepatico-A - hepatico-duodenostomy duodenostomy with transhepatic with transhepatic drainagedrainage

• B - hepatico-B - hepatico-jejunostomy with jejunostomy with two transhepatic two transhepatic drainagedrainage

Nature of postoperative complicationsNature of postoperative complications

№ COMPLICATIONS number of cases:

numb. of reoper.:

lethal outcomes:

I SPECIFIC COMPLICATIONS: 41(13,8%) 8 (3,1%) 3(1,0%)

a. Suppuration of sutured residual cavity:

2 (0,7%) 2 (0,7%) ---

b. Suppuration of drained residual cavity with formation of external biliary and purulent fistula:

33 (11,0%) 2 (0,7%) ---

c Hemorrhage in residual cavity: 2 (0,7%) 2 (0,7%) ---

d.

Cholangitis, acute hepato-renal failure: 2 (0,7%) 1 (0,3%) 2 (0,7%)

e. Subdiaphragmal and subhepatic abscesses

2 (0,7%) 2 (0,7%) 1 (0,3%)

II NON-SPECIFIC COMPLICATIONS:38 (12,7%) ---- 2 (0,7%)

Total: 79 (26,5%) 8 (3,1%)8 (3,1%) 5 (1,7%)

Factors affecting morbidity & Factors affecting morbidity & mortality in postoperative mortality in postoperative

periodperiod• Age of patients over 60 yearsAge of patients over 60 years

• Duration of disease more than 5 yearsDuration of disease more than 5 years

• Localization of cysts in central (I,IV) Localization of cysts in central (I,IV) segments of liversegments of liver

• Size of cysts more than 10 cmSize of cysts more than 10 cm

• Complications of echinococcosis Complications of echinococcosis (suppuration & calcination of cysts, (suppuration & calcination of cysts, lesions of bile ducts)lesions of bile ducts)

• Type of operation (drainage of Type of operation (drainage of residual cavity)residual cavity)

Thanks for your attention

Looking forward to see you in Baku