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CASE REPORT
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 204-206

Unusual presentation of a recurrent hydatid of the liver


Department of Surgical Gastroenterology, Narayana Medical College, Chintareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication17-Sep-2018

Correspondence Address:
Dr. Tripuraneni Venkata Aditya Chowdary
Department of Surgical Gastroenterology, Narayana Medical College, Chintareddypalem, Nellore - 524 002, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.241283

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  Abstract 


Hydatid disease of the liver is still a common disease in our country with the involvement of the liver being the most common. Recurrence after surgery is, usually, confined to the liver, or generalized dissemination occurs throughout the peritoneal cavity. A female patient presented with a glistening swelling in the right upper quadrant of 6 month's duration. She was previously operated for a hepatic hydatid. She was investigated and found to have a hepatic recurrence infiltrating into the subcutaneous tissue. She underwent excision of the same. This case is being reported as for it is uncommon for a hepatic hydatid to present as a subcutaneous cyst.

Keywords: Cystopericystectomy, Echinococcosis, hepatic hydatid, hepatic therapy, recurrence


How to cite this article:
Chowdary TV, Sivaraj SM, Reddy BJ, Thirunavukkarasu S. Unusual presentation of a recurrent hydatid of the liver. J NTR Univ Health Sci 2018;7:204-6

How to cite this URL:
Chowdary TV, Sivaraj SM, Reddy BJ, Thirunavukkarasu S. Unusual presentation of a recurrent hydatid of the liver. J NTR Univ Health Sci [serial online] 2018 [cited 2018 Dec 18];7:204-6. Available from: http://www.jdrntruhs.org/text.asp?2018/7/3/204/241283




  Introduction Top


Hydatid disease is a parasitic infestation caused by Echinococcosis granuloses, Echinococcosis oligarthus, Echinococcosis multilocularis, Echinococcosis vogilie with E. Granuloses being the most common. The most common site of involvement in man who acts as an accidental host is the liver (2/3rd of the cases). Recurrence after resection is around 10%.[1] Generalized involvement of the peritoneum post resection is common if adequate care is not taken.[2] However, hepatic recurrences manifesting subcutaneously is not common. A detailed search of the literature revealed only few such cases and hence this case is reported.[3]


  Case Report Top


A 45-year-old female patient presented with a glistening 4 cm × 3 cm swelling in the right lateral abdominal wall for the past 6 months [Figure 1]. It had been slowly increasing in size and on presentation was tender. No other masses were palpable. The patient had undergone open resection for a hydatid 6 years back. Ultrasound showed an 8 cm × 5 cm × 3 cm cystic swelling in the right lobe of the liver extending into the abdominal wall.
Figure 1: A glistening cystic swelling in the right flank

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A course of Albendazole was started at 10 mg/kg body weight for a week before the procedure. Under general anesthesia, laparotomy was done. A cystic swelling was present from the inferior surface of the liver involving segments 4b and 5 and extending into the lateral abdominal wall was found [Figure 2]. The cyst was aspirated, and 20% saline was injected into the cyst as a scolicidal agent. Cystopericystectomy was done along with removal of the part of the cyst adherent to the anterior abdominal wall. There was no spillage or any bile leak. A drain was placed in the residual cavity and abdomen was closed.
Figure 2: Recurrent hepatic hydatid cyst extending into the parital wall

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Postoperatively, patient was put on 3 cycles of albendazole 10 mg/kg body weight for 28 days along with a 2 week interval. Follow-up ultrasound done at 1 year did not show any sign of recurrence.


  Discussion Top


Hydatid disease is very prevalent in South India and is especially common in the states of Andhra Pradesh and Tamil Nadu.[4] The most common site of involvement is the liver followed by the lung.[5] Only around 10% occur in sites other than these with involvement of the musculoskeletal system only being reported anecdotally.

Echinococcosis may be asymptomatic for many years, its presence becoming evident when the liver is found to be enlarged, or a cystic lesion is noted on imaging.[6] Symptoms due to a hydatid, usually, are only a dragging pain due to the size and weight of the lesion and complications of it.[7] The known common complications are rupture into the peritoneal cavity, infection, compression and erosion of the biliary tree, anaphylaxis.[8] Rare modes of rupture are fistulization into the duodenum, perforation of the diaphragm, infiltration of ribs, and rupture into the vascular and urinary system.[9]

Diagnosis of hydatid disease should prompt therapy to alleviate symptoms, halt the progression of infection, and prevent complications. Traditionally, open surgical resection or drainage has been standard therapy. Recently, laparoscopic and percutaneous therapies have been evaluated and gained favor as alternatives to open operation.

Recurrence after surgery usually occurs as a result of spillage into the peritoneal cavity of the contents (mean time of presentation 60.5 months [10]) or as a result of missing another cyst.[11] However the recurrence confines itself to the cavity involved or to the organ involved such as abdominal spillage results in diffuse abdominal metastasis. Recurrence in an organ and it then involving the subcutaneous tissue is very rare with only a few cases being reported in the literature.[2]

The main reasons for hepatic recurrence are failure to remove all viable cysts at inaccessible or difficult locations or to leave a residual cyst wall at the initial operation. When the recurrence occurs and involves the subcutaneous tissues, the most common site is the right hypochondrium, followed by the epigastrium. Recurrences have also been reported in the umbilicus and the thoracic wall.

Management of recurrences is a challenge as re-recurrence also occurs and is reported to be as high as 27%. Early identification and diagnosis are vital in the management. Surgical management combined along with medical therapy is the pillar of treatment. When symptomatic and not disseminated, surgery along with systemic chemotherapy with albendazole is given.

Management of a hepatic hydatid with a cutaneous fistula involves preoperative chemotherapy with albendazole, followed by surgical excision of the hepatic cyst, the cutaneous tract and the involved skin. Care should be taken to avoid spillage. When a patient is unfit to undergo any surgical procedure medical therapy alone may be given.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sielaff TD, Taylor B, Langer B. Recurrence of hydatid disease. World J Surg 2001;25:83-6.  Back to cited text no. 1
    
2.
Kapan M, Kapan S, Goksoy E, Perek S, Kol E. Postoperative recurrence in hepatic hydatid disease. J Gastrointest Surg 2006;10:734-9.  Back to cited text no. 2
    
3.
Korwar V, Subhas G, Gaddikeri P, Shivaswamy BS. Hydatid disease presenting as cutaneous fistula: Review of a rare clinical presentation. Int Surg 2011;96:69-73.  Back to cited text no. 3
    
4.
Tiwary AK, Tiwary RN. Hydatid disease in chotanagpur region of South Bihar. Indian J Surg 1988;50:14-8.  Back to cited text no. 4
    
5.
Biswas D, Dey A, Biswas S, Chakraborty M. It's easy to miss complicated hydatid cyst of lung. Lung India 2010;27:164-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Frider B, Larrieu E, Odriozola M. Long-term outcome of asymptomatic liver hydatidosis. J Hepatol 1999;30:228-31.  Back to cited text no. 6
    
7.
Datta A, Ghosh SK, Dasgupta A, De A. Hydatid cyst of liver: A case with an unusual clinical presentation. Indian J Med Sci 2011;65:543-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Mudgalkar N, Nagpadma, Sharley. Perioperative anaphylaxis – Our experience of two cases. Natl J Med Res 2012;2:93-5.  Back to cited text no. 8
    
9.
Spinelli C, Berti P, Gori L, Pierallini S, Miccoli P. Extrahepatic abdominal hydatidosis: Surgical features of 11 cases. Ital J Gastroenterol 1992;24:446-8.  Back to cited text no. 9
    
10.
Kapan M, Kapan S, Goksoy E, Perek S, Kol E. Postoperative recurrence in hepatic hydatid disease. J Gastrointest Surg 2006;10:734-9.  Back to cited text no. 10
    
11.
Prousalidis J, Kosmidis C, Anthimidis G, Kapoutzis K, Karamanlis E, Fachantidis E. Postoperative recurrence of cystic hydatidosis. Can J Surg 2012;55:15-20.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

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