Hepatic hydatid disease is caused by the larval stage of Echinococcus granulosus. Ultrasound is the initial imaging test of choice, with CT and MRI providing additional details. Serological tests are used to diagnose infection, while ultrasound classification systems describe cyst appearance and guide management. Surgical techniques, imaging advances, and improved diagnosis have led to decreased morbidity and mortality from hepatic hydatid disease.
Hydatid disease of liver,by. Dr. Bashab Roy,PGT, SMCDr.Bashab Roy
This document discusses hydatid disease of the liver, caused by the larval stage of the dog tapeworm Echinococcus granulosus. It spreads to humans through contact with infected dog feces. The larva can form cysts in the liver which grow slowly over months. Symptoms include abdominal pain and swelling. Diagnosis involves blood tests, imaging like ultrasound and CT scan, and detection of antibodies. Conservative surgery aims to remove the cyst contents safely while leaving the surrounding tissue intact, while radical surgery completely removes the cyst and surrounding layers. Percutaneous treatments like puncture, aspiration and injection can also be used but risk anaphylaxis and local recurrence. Untreated cysts can rupture and cause life-threatening
Hydatid cyst of the liver, also known as echinococcosis, is caused by the larval stage of the Echinococcus tapeworm. Humans can become infected by ingesting tapeworm eggs from infected animal feces. The parasite then develops into a hydatid cyst in the liver or lungs. A hydatid cyst grows slowly and can reach a large size, sometimes replacing an entire liver lobe. It consists of an outer layer (ectocyst) and inner layer (endocyst) that produces cyst fluid and daughter cysts. Rupture of the cyst can lead to spread of the parasite within the abdomen or chest. Imaging such as ultrasound and CT are important for diagnosis and show cyst
The document provides information on hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It discusses the life cycle of the parasite, symptoms, investigations including imaging techniques, classification of cysts, treatment options including surgery, percutaneous drainage (PAIR procedure), and chemotherapy. PAIR involves puncturing the cyst, injecting a scolicidal agent, and reaspirating the contents to treat the cyst minimally invasively.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document provides guidelines for laparoscopic cholecystectomy. It outlines indications for the procedure including symptomatic gallstones and acute cholecystitis. High-risk patients for bile duct stones are evaluated preoperatively with ERCP. The basic operative technique is described including abdominal access and establishing the critical view of safety. Intraoperative cholangiography is routinely performed to detect common bile duct stones which may be treated endoscopically or with exploration. Conversion to open surgery should be considered for infected or scarred gallbladders or if the anatomy cannot be clearly defined. Major complications are bile duct injury and bleeding.
The document summarizes key information about hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It describes the parasite's lifecycle between dogs and intermediate hosts like sheep and humans. Symptoms arise when the slow-growing cyst presses on organs or complications occur. Investigations include serology, ultrasound, CT and MRI. Treatment involves surgery to remove the cyst along with scolicidal agents or percutaneous drainage preceded by albendazole therapy. Complications can include biliary leakage, infection and recurrence.
This document discusses obstructed defecation syndrome (ODS). It defines ODS as difficulty evacuating the rectum that may be associated with constipation. Common causes include diet, medications, and pelvic floor disorders. ODS is caused by abnormal function of muscles involved in defecation or anatomical abnormalities of pelvic organs. Diagnosis involves questionnaires, tests like defecography, and the ODS score. Treatment depends on the underlying cause and may include conservative options, biofeedback, or surgical procedures like STARR to repair defects.
Hydatid cyst of the liver is very rare problem in the urban population of INDIA. However, we must know the disease its presentation, the review of literature for the same and its management with current updates.
Hydatid disease of liver,by. Dr. Bashab Roy,PGT, SMCDr.Bashab Roy
This document discusses hydatid disease of the liver, caused by the larval stage of the dog tapeworm Echinococcus granulosus. It spreads to humans through contact with infected dog feces. The larva can form cysts in the liver which grow slowly over months. Symptoms include abdominal pain and swelling. Diagnosis involves blood tests, imaging like ultrasound and CT scan, and detection of antibodies. Conservative surgery aims to remove the cyst contents safely while leaving the surrounding tissue intact, while radical surgery completely removes the cyst and surrounding layers. Percutaneous treatments like puncture, aspiration and injection can also be used but risk anaphylaxis and local recurrence. Untreated cysts can rupture and cause life-threatening
Hydatid cyst of the liver, also known as echinococcosis, is caused by the larval stage of the Echinococcus tapeworm. Humans can become infected by ingesting tapeworm eggs from infected animal feces. The parasite then develops into a hydatid cyst in the liver or lungs. A hydatid cyst grows slowly and can reach a large size, sometimes replacing an entire liver lobe. It consists of an outer layer (ectocyst) and inner layer (endocyst) that produces cyst fluid and daughter cysts. Rupture of the cyst can lead to spread of the parasite within the abdomen or chest. Imaging such as ultrasound and CT are important for diagnosis and show cyst
The document provides information on hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It discusses the life cycle of the parasite, symptoms, investigations including imaging techniques, classification of cysts, treatment options including surgery, percutaneous drainage (PAIR procedure), and chemotherapy. PAIR involves puncturing the cyst, injecting a scolicidal agent, and reaspirating the contents to treat the cyst minimally invasively.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
This document provides guidelines for laparoscopic cholecystectomy. It outlines indications for the procedure including symptomatic gallstones and acute cholecystitis. High-risk patients for bile duct stones are evaluated preoperatively with ERCP. The basic operative technique is described including abdominal access and establishing the critical view of safety. Intraoperative cholangiography is routinely performed to detect common bile duct stones which may be treated endoscopically or with exploration. Conversion to open surgery should be considered for infected or scarred gallbladders or if the anatomy cannot be clearly defined. Major complications are bile duct injury and bleeding.
The document summarizes key information about hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It describes the parasite's lifecycle between dogs and intermediate hosts like sheep and humans. Symptoms arise when the slow-growing cyst presses on organs or complications occur. Investigations include serology, ultrasound, CT and MRI. Treatment involves surgery to remove the cyst along with scolicidal agents or percutaneous drainage preceded by albendazole therapy. Complications can include biliary leakage, infection and recurrence.
This document discusses obstructed defecation syndrome (ODS). It defines ODS as difficulty evacuating the rectum that may be associated with constipation. Common causes include diet, medications, and pelvic floor disorders. ODS is caused by abnormal function of muscles involved in defecation or anatomical abnormalities of pelvic organs. Diagnosis involves questionnaires, tests like defecography, and the ODS score. Treatment depends on the underlying cause and may include conservative options, biofeedback, or surgical procedures like STARR to repair defects.
Hydatid cyst of the liver is very rare problem in the urban population of INDIA. However, we must know the disease its presentation, the review of literature for the same and its management with current updates.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
This document discusses the management of enterocutaneous fistulas (ECF). The goals of management are to control sepsis, provide nutritional support, define the intestinal anatomy, and develop a surgical procedure. Investigations such as fistulography and imaging modalities are used to characterize the fistula. Nutritional support may involve enteral or parenteral nutrition depending on the location and output of the fistula. Controlling drainage and skin care is important for wound healing. Surgical intervention is considered if non-operative measures fail.
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
Bile duct injuries are a complex complication seen more frequently with laparoscopic cholecystectomies due to aberrant anatomy and increased procedures. They can involve the cystic duct, gallbladder bed, or major bile ducts. Various classification systems exist to describe the level and extent of injury. Injuries may be detected intraoperatively by cholangiogram abnormalities, bile drainage from unusual locations, or anomalous anatomy. Prevention strategies include proper case selection, opening retroperitoneal folds, dissecting close to the gallbladder, achieving the critical view of safety, and using intraoperative cholangiography.
TG13: Updated Tokyo guidelines for acute cholecystitis Jibran Mohsin
The document provides updated guidelines for the diagnosis and management of acute cholecystitis from the Tokyo Guidelines 2013. It details the terminology, etiology, epidemiology, diagnostic criteria including signs, symptoms, imaging and laboratory findings. It establishes criteria for grading the severity of acute cholecystitis cases. The management section outlines antimicrobial therapy, options for gallbladder drainage, and surgical management. Key points include utilizing ultrasonography for initial diagnosis assessment and defining diagnostic criteria as localized signs of inflammation plus systemic signs of inflammation along with imaging characteristics of acute cholecystitis.
Journal club-Determination of surgical priorities in appendicitisYouttam Laudari
This study aimed to identify risk factors for actual appendiceal perforation in patients diagnosed with non-perforated appendicitis by CT scan. The researchers conducted a retrospective case-control study of 1362 patients at a hospital in South Korea between 2006-2013. They found age over 35, temperature over 37.7°C, neutrophil count over 65%, and appendiceal diameter over 8mm were associated with actual perforation. The study identified body temperature, symptom duration, age, and appendiceal diameter as independent risk factors to help determine surgical priority and reduce complications from undiagnosed perforation.
This document discusses surgical approaches for esophageal cancer. It covers:
- Esophageal anatomy, blood supply, lymph drainage
- Staging of esophageal cancer and criteria for resection
- Preoperative evaluation including imaging, biopsy, and laparoscopy
- Surgical procedures for cervical, thoracic, and esophagogastric junction cancers including transhiatal esophagectomy, Ivor-Lewis procedure, and tri-incisional esophagectomy
- Oncologic principles for lymphadenectomy and margins during resection
Types of intestinal stomas and management Ankita Singh
The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
This document discusses bile duct injuries during cholecystectomy. It notes that the incidence of bile duct injuries is higher in laparoscopic compared to open cholecystectomy. Anatomical variations contribute to injuries, and dissection errors where the bile duct is mistaken for the cystic duct are common. Intraoperative cholangiography and fluorescence imaging can help identify ducts but may not prevent injuries. Several classification systems for bile duct injuries are described. Management depends on the type and severity of injury, ranging from repair to hepaticojejunostomy. Preventing medicolegal issues requires thorough informed consent, documentation, transparency if complications occur, and promptly involving specialists.
This document provides information on hydatid disease, which is caused by the parasitic tapeworm Echinococcus. It begins with a brief history of hydatid disease and descriptions of the Echinococcus species that cause it. It then discusses the life cycle of the parasite, passing between definitive hosts like dogs and intermediate hosts like sheep. Clinical features vary depending on the infected organ but may include abdominal pain or swelling. Diagnosis involves immunological tests and imaging modalities like ultrasound or CT. Untreated cases can lead to organ damage or failure.
Choledochal cyst is a congenital abnormality of the biliary tree that results in dilatation of the bile ducts. It is most common in Asia, with various theories proposed for its pathogenesis including abnormalities in bile duct remodeling during embryogenesis or obstruction leading to cyst formation. Patients may present with jaundice, abdominal pain or a mass. Diagnosis is typically made using ultrasound, CT or MRCP imaging. Surgical excision of the cyst and biliary reconstruction is the primary treatment for types I-IV, while type III may be treated endoscopically and type V depends on extent of liver involvement.
Hydatid cyst of the liver is caused by infection with the larval stage of Echinococcus tapeworms. The cysts grow slowly over years and can reach large sizes. Symptoms vary depending on cyst location and complications. Diagnosis involves blood tests, imaging like ultrasound or CT, and serologic tests. Treatment options include medical therapy with albendazole, percutaneous drainage with scolicidal agents (PAIR procedure), or surgical removal of cysts. Surgery aims to remove all cyst components while avoiding spillage, and techniques depend on cyst location and number. Postoperative medical treatment helps prevent recurrence. Long term follow up with imaging and serology is needed to monitor for recurrence.
This document discusses hydatid cyst, which is caused by the larval stage of Echinococcus granulosus. It can infect the liver and lungs in humans. The life cycle involves dogs and other carnivores as the definitive host, where the adult worm lives in the small intestine, and sheep as the common intermediate host. Humans can become infected through contact with dog feces or contaminated food or water. Symptoms vary but include abdominal pain and hepatomegaly. Diagnosis involves imaging like ultrasound or CT scan. Treatment involves albendazole, surgery to remove the cyst while preventing spillage, or percutaneous drainage with scolicidal agents. Complications include rupture, infection, and anaphylaxis.
This document discusses laparoscopic cholecystectomy (LC), including:
- The history and development of LC since its invention in 1985.
- The standard four-port technique for LC and strategies to minimize bile duct injuries like adopting the Critical View of Safety method.
- Potential complications of LC like hemorrhage, bile leak, and bile duct injury which can occur if the hepatocystic triangle anatomy is not correctly identified.
- Techniques to help identify anatomy like intraoperative cholangiography and using landmarks like Rouviere's sulcus and the epicholedochal plexus.
This document discusses hydatid cyst of the liver, which is caused by the parasite Echinococcus granulosus transmitted by dogs. After being swallowed, the parasite's eggs penetrate the stomach and travel to the liver through blood vessels. In the liver, they grow and form hydatid cysts with multiple protective layers. Hydatid cysts can be asymptomatic or cause abdominal pain. Diagnosis involves imaging and blood tests. Treatment options include surgery to remove cysts, medication with albendazole, or watchful waiting for inactive cysts.
1. The patient presented with intermittent right upper abdominal pain for 2 years with associated low grade fever. Imaging showed multiple hydatid cysts in the liver.
2. Hydatid cyst disease is caused by the larval stage of Echinococcus granulosus. Humans can become infected by contact with definitive hosts like dogs or ingesting contaminated food or water.
3. Treatment options include albendazole medication, puncturing and draining cysts using PAIR technique, or surgery to remove cysts depending on number and location.
This document discusses hydatid disease, caused by a tapeworm that infects dogs, dingoes and foxes. It forms cysts in the internal organs of intermediate hosts like humans, especially the liver and lungs. The disease requires surgery for treatment. Control involves eliminating the tapeworm from dogs. With better control in livestock and dogs, wildlife are becoming a relatively more important threat to human health. Symptoms vary depending on the infected organ, such as jaundice and pain for liver involvement, and coughing for lung cysts. Prevention focuses on hygiene and deworming dogs. The document then examines clinical signs and images of hydatid cysts in various body organs.
Post-cholecystectomy complications can be early or late, biliary or non-biliary. Early complications include bile leak, hematoma, abscess, and dropped stones. Late complications include port site hernia, postoperative pain, stricture, and retained stones. The risk of these complications is higher with laparoscopic cholecystectomy during acute cholecystitis and for inexperienced surgeons. Important prevention strategies include surgical experience, proper technique such as obtaining the critical view of safety, and conversion to open when needed.
This document provides an overview of hydatid disease caused by the tapeworm Echinococcus granulosus. It discusses the life cycle, pathogenesis, clinical presentation, diagnosis using imaging like ultrasound and CT, and various treatment options including drug therapy, percutaneous drainage, surgery. Surgical removal remains the mainstay of treatment for complicated cysts while newer minimally-invasive techniques like PAIR are gaining popularity for selected cases.
The document discusses hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It summarizes the life cycle, pathology, clinical features, investigations including imaging techniques, and treatment options for hydatid cyst. Treatment options include medical treatment with albendazole, percutaneous drainage using the PAIR technique, endoscopic management for biliary involvement, and surgical options. PAIR involves puncturing the cyst under imaging guidance, injecting a scolicidal agent, and reaspirating the contents.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
This document discusses the management of enterocutaneous fistulas (ECF). The goals of management are to control sepsis, provide nutritional support, define the intestinal anatomy, and develop a surgical procedure. Investigations such as fistulography and imaging modalities are used to characterize the fistula. Nutritional support may involve enteral or parenteral nutrition depending on the location and output of the fistula. Controlling drainage and skin care is important for wound healing. Surgical intervention is considered if non-operative measures fail.
Biliary stricture is an abnormal narrowing of the bile duct. The most common cause is injury during cholecystectomy, accounting for 80% of non-malignant strictures. Bile duct injury can cause inflammation, fibrosis, scarring, and cirrhosis. Surgical treatment depends on when the injury is recognized, with immediate repair during surgery or delayed repair weeks later being options. Roux-en-Y hepaticojejunostomy is a common repair method that involves a mucosa-to-mucosa anastomosis of the bile duct to the jejunum. Factors like multiple prior repairs, proximal strictures, and surgeon inexperience can lead to poor outcomes.
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
Resection & anastomosis of boweL its complications PRANAYA PPTPRANAYA PANIGRAHI
This document discusses intestinal resection and anastomosis. It defines anastomosis as establishing communication between two portions of intestine after removal of diseased bowel. Factors that influence healing, techniques for performing anastomoses (hand sewn vs. stapling), and common complications are described. Maintaining adequate blood supply, tension-free closure, and paying attention to technical details are emphasized for achieving successful anastomotic healing.
Bile duct injuries are a complex complication seen more frequently with laparoscopic cholecystectomies due to aberrant anatomy and increased procedures. They can involve the cystic duct, gallbladder bed, or major bile ducts. Various classification systems exist to describe the level and extent of injury. Injuries may be detected intraoperatively by cholangiogram abnormalities, bile drainage from unusual locations, or anomalous anatomy. Prevention strategies include proper case selection, opening retroperitoneal folds, dissecting close to the gallbladder, achieving the critical view of safety, and using intraoperative cholangiography.
TG13: Updated Tokyo guidelines for acute cholecystitis Jibran Mohsin
The document provides updated guidelines for the diagnosis and management of acute cholecystitis from the Tokyo Guidelines 2013. It details the terminology, etiology, epidemiology, diagnostic criteria including signs, symptoms, imaging and laboratory findings. It establishes criteria for grading the severity of acute cholecystitis cases. The management section outlines antimicrobial therapy, options for gallbladder drainage, and surgical management. Key points include utilizing ultrasonography for initial diagnosis assessment and defining diagnostic criteria as localized signs of inflammation plus systemic signs of inflammation along with imaging characteristics of acute cholecystitis.
Journal club-Determination of surgical priorities in appendicitisYouttam Laudari
This study aimed to identify risk factors for actual appendiceal perforation in patients diagnosed with non-perforated appendicitis by CT scan. The researchers conducted a retrospective case-control study of 1362 patients at a hospital in South Korea between 2006-2013. They found age over 35, temperature over 37.7°C, neutrophil count over 65%, and appendiceal diameter over 8mm were associated with actual perforation. The study identified body temperature, symptom duration, age, and appendiceal diameter as independent risk factors to help determine surgical priority and reduce complications from undiagnosed perforation.
This document discusses surgical approaches for esophageal cancer. It covers:
- Esophageal anatomy, blood supply, lymph drainage
- Staging of esophageal cancer and criteria for resection
- Preoperative evaluation including imaging, biopsy, and laparoscopy
- Surgical procedures for cervical, thoracic, and esophagogastric junction cancers including transhiatal esophagectomy, Ivor-Lewis procedure, and tri-incisional esophagectomy
- Oncologic principles for lymphadenectomy and margins during resection
Types of intestinal stomas and management Ankita Singh
The document discusses types of intestinal stomas including classifications based on duration, anatomical location, and reconstruction. It covers indications for stoma creation, principles of stoma formation including challenges, common complications, and dietary advice for ostomates. Stoma appliances and management of various stoma-related complications are also described.
This document discusses bile duct injuries during cholecystectomy. It notes that the incidence of bile duct injuries is higher in laparoscopic compared to open cholecystectomy. Anatomical variations contribute to injuries, and dissection errors where the bile duct is mistaken for the cystic duct are common. Intraoperative cholangiography and fluorescence imaging can help identify ducts but may not prevent injuries. Several classification systems for bile duct injuries are described. Management depends on the type and severity of injury, ranging from repair to hepaticojejunostomy. Preventing medicolegal issues requires thorough informed consent, documentation, transparency if complications occur, and promptly involving specialists.
This document provides information on hydatid disease, which is caused by the parasitic tapeworm Echinococcus. It begins with a brief history of hydatid disease and descriptions of the Echinococcus species that cause it. It then discusses the life cycle of the parasite, passing between definitive hosts like dogs and intermediate hosts like sheep. Clinical features vary depending on the infected organ but may include abdominal pain or swelling. Diagnosis involves immunological tests and imaging modalities like ultrasound or CT. Untreated cases can lead to organ damage or failure.
Choledochal cyst is a congenital abnormality of the biliary tree that results in dilatation of the bile ducts. It is most common in Asia, with various theories proposed for its pathogenesis including abnormalities in bile duct remodeling during embryogenesis or obstruction leading to cyst formation. Patients may present with jaundice, abdominal pain or a mass. Diagnosis is typically made using ultrasound, CT or MRCP imaging. Surgical excision of the cyst and biliary reconstruction is the primary treatment for types I-IV, while type III may be treated endoscopically and type V depends on extent of liver involvement.
Hydatid cyst of the liver is caused by infection with the larval stage of Echinococcus tapeworms. The cysts grow slowly over years and can reach large sizes. Symptoms vary depending on cyst location and complications. Diagnosis involves blood tests, imaging like ultrasound or CT, and serologic tests. Treatment options include medical therapy with albendazole, percutaneous drainage with scolicidal agents (PAIR procedure), or surgical removal of cysts. Surgery aims to remove all cyst components while avoiding spillage, and techniques depend on cyst location and number. Postoperative medical treatment helps prevent recurrence. Long term follow up with imaging and serology is needed to monitor for recurrence.
This document discusses hydatid cyst, which is caused by the larval stage of Echinococcus granulosus. It can infect the liver and lungs in humans. The life cycle involves dogs and other carnivores as the definitive host, where the adult worm lives in the small intestine, and sheep as the common intermediate host. Humans can become infected through contact with dog feces or contaminated food or water. Symptoms vary but include abdominal pain and hepatomegaly. Diagnosis involves imaging like ultrasound or CT scan. Treatment involves albendazole, surgery to remove the cyst while preventing spillage, or percutaneous drainage with scolicidal agents. Complications include rupture, infection, and anaphylaxis.
This document discusses laparoscopic cholecystectomy (LC), including:
- The history and development of LC since its invention in 1985.
- The standard four-port technique for LC and strategies to minimize bile duct injuries like adopting the Critical View of Safety method.
- Potential complications of LC like hemorrhage, bile leak, and bile duct injury which can occur if the hepatocystic triangle anatomy is not correctly identified.
- Techniques to help identify anatomy like intraoperative cholangiography and using landmarks like Rouviere's sulcus and the epicholedochal plexus.
This document discusses hydatid cyst of the liver, which is caused by the parasite Echinococcus granulosus transmitted by dogs. After being swallowed, the parasite's eggs penetrate the stomach and travel to the liver through blood vessels. In the liver, they grow and form hydatid cysts with multiple protective layers. Hydatid cysts can be asymptomatic or cause abdominal pain. Diagnosis involves imaging and blood tests. Treatment options include surgery to remove cysts, medication with albendazole, or watchful waiting for inactive cysts.
1. The patient presented with intermittent right upper abdominal pain for 2 years with associated low grade fever. Imaging showed multiple hydatid cysts in the liver.
2. Hydatid cyst disease is caused by the larval stage of Echinococcus granulosus. Humans can become infected by contact with definitive hosts like dogs or ingesting contaminated food or water.
3. Treatment options include albendazole medication, puncturing and draining cysts using PAIR technique, or surgery to remove cysts depending on number and location.
This document discusses hydatid disease, caused by a tapeworm that infects dogs, dingoes and foxes. It forms cysts in the internal organs of intermediate hosts like humans, especially the liver and lungs. The disease requires surgery for treatment. Control involves eliminating the tapeworm from dogs. With better control in livestock and dogs, wildlife are becoming a relatively more important threat to human health. Symptoms vary depending on the infected organ, such as jaundice and pain for liver involvement, and coughing for lung cysts. Prevention focuses on hygiene and deworming dogs. The document then examines clinical signs and images of hydatid cysts in various body organs.
Post-cholecystectomy complications can be early or late, biliary or non-biliary. Early complications include bile leak, hematoma, abscess, and dropped stones. Late complications include port site hernia, postoperative pain, stricture, and retained stones. The risk of these complications is higher with laparoscopic cholecystectomy during acute cholecystitis and for inexperienced surgeons. Important prevention strategies include surgical experience, proper technique such as obtaining the critical view of safety, and conversion to open when needed.
This document provides an overview of hydatid disease caused by the tapeworm Echinococcus granulosus. It discusses the life cycle, pathogenesis, clinical presentation, diagnosis using imaging like ultrasound and CT, and various treatment options including drug therapy, percutaneous drainage, surgery. Surgical removal remains the mainstay of treatment for complicated cysts while newer minimally-invasive techniques like PAIR are gaining popularity for selected cases.
The document discusses hydatid cyst of the liver caused by the larva of the dog tapeworm Echinococcus granulosus. It summarizes the life cycle, pathology, clinical features, investigations including imaging techniques, and treatment options for hydatid cyst. Treatment options include medical treatment with albendazole, percutaneous drainage using the PAIR technique, endoscopic management for biliary involvement, and surgical options. PAIR involves puncturing the cyst under imaging guidance, injecting a scolicidal agent, and reaspirating the contents.
This document summarizes information about hydatid cysts, which are caused by infection with the larval stage of the Echinococcus tapeworm. It describes the lifecycle of E. granulosus and how humans can become infected through contact with dog feces. Hydatid cysts most commonly form in the liver and lungs, and may grow slowly over many years without symptoms. Clinical features depend on the infected organ and size of cysts. Imaging tests and serology can help diagnose cysts, while treatment involves antiparasitic drugs, percutaneous drainage, or surgical removal based on cyst type and location. Close follow up is needed due to risk of recurrence.
Liver hydatid disease is caused by the larva of the dog tapeworm Echinococcus granulosus. Humans can become infected by ingesting the tapeworm's eggs from contact with infected dog feces. The larva travels to the liver where it forms a hydatid cyst. Symptoms are usually mild until complications occur. Diagnosis involves serological tests and imaging such as ultrasound or CT scan which can identify cyst characteristics. Treatment options include medication, minimally invasive techniques such as PAIR, or surgery depending on cyst location and size.
Liver hydatid disease is caused by the larva of the dog tapeworm Echinococcus granulosus. Humans can become infected by ingesting parasite eggs from dog feces. Ultrasound is the primary diagnostic tool, showing cysts that may contain daughter cysts. Treatment options include surgery, chemotherapy with albendazole, and minimally invasive techniques like PAIR which involve puncturing and draining the cysts.
Hints about tuberculosis , Epididymis anatomy and functions, Epididymis infection with TB, Incidence, Clinical picture and complications of it, Hints about the diagnosis and treatment
Presented in the department of Urology, Sohag school of medicine
Hydatid cyst disease of the liver الدكتور طارق المنيزل Tariq Al munaizel
Echinococcus granulosus is a parasitic tapeworm that causes hydatid disease (hydatidosis) in humans. Its life cycle involves carnivores as definitive hosts and herbivores as intermediate hosts. Humans can be infected by ingesting E. granulosus eggs from a definitive host. The larvae develop into hydatid cysts, most commonly in the liver. Hydatid cysts can cause symptoms from pressure or complications like rupture. Diagnosis involves imaging and serology. Treatment depends on cyst type and complications but may include surgery, percutaneous drainage, or antiparasitic drugs.
An 26-year-old female presented with abdominal pain, hepatomegaly, and fever. Imaging revealed hepatic cysts, with differential diagnoses including cystic echinococcosis. Cystic echinococcosis is caused by the tapeworm Echinococcus granulosus and is endemic in pastoral communities. It involves the growth of cysts, most commonly in the liver and lungs, which can cause complications as they increase in size. Diagnosis involves serology, imaging, and cyst puncture. Treatment options include benzimidazole medication, percutaneous cyst sterilization, surgery, or observation of asymptomatic cysts. Prevention requires reducing transmission between definitive canine hosts and intermediate livestock hosts.
Pyogenic and amebic liver abscesses can develop from a variety of causes. Ultrasound or CT imaging are used to identify abscesses, which appear as hypoechoic or low attenuation areas on scans. Treatment involves intravenous antibiotics along with drainage of larger abscesses via needle aspiration or catheter placement. For pyogenic abscesses, antibiotics are chosen based on culture results and typically include combinations targeting common bacteria. Amebic abscesses are generally treated with metronidazole or other nitroimidazole antibiotics, sometimes along with drainage or other antiparasitic drugs. Complications can arise if abscesses rupture or spread beyond the liver.
This document provides tips and instructions for using a PowerPoint presentation on Hydatid disease:
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this presentation includes anatomy physiology function of peritoneum ,also includes cause of peritonitis its severity ,various scoring system investigation and treatment.It includes the recent advancement and latest articles from latest books of surgery.
Liver abscesses occur when bacteria, protozoa, or fungi infect and destroy hepatic tissue. There are two main types: pyogenic (caused by bacteria) and amebic (caused by the protozoan Entamoeba histolytica). Common symptoms include fever, right upper quadrant pain, and hepatomegaly. Imaging tests like ultrasound and CT are used to detect abscesses. Treatment involves antibiotics, drainage of large abscesses, and treating any underlying infection. Outcomes are generally good but complications can include sepsis, empyema, and rupture.
Echinococcosis is a parasitic disease caused by tapeworms of the Echinococcus genus. There are four main types: cystic, alveolar, polycystic, and unicystic. Cystic echinococcosis is the most common type and is caused by E. granulosus. It often presents without symptoms and may persist for years. Diagnosis is usually made using imaging like CT, MRI, or ultrasound along with serology tests. Treatment involves surgical removal of cysts combined with chemotherapy using albendazole before and after surgery.
This document provides an overview of cholecystitis, including:
1. It defines cholecystitis as the inflammatory condition of the gallbladder and describes the types of acute cholecystitis.
2. It outlines the clinical features of acute cholecystitis including symptoms like colicky pain and signs like Murphy's sign.
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Hydatid cysts, caused by the larval stage of the Echinococcus tapeworm, most commonly involve the liver. A 25-year-old female presented with abdominal pain and was found to have a hydatid cyst in her liver based on imaging. Treatment options for liver cysts include surgical removal, percutaneous drainage with injection of a scolicidal agent (PAIR), and medical therapy with benzimidazole drugs. Complete surgical removal offers the lowest risk of recurrence but higher risks of complications, while PAIR and medical therapy have lower risks but higher chances of incomplete treatment or relapse.
This document summarizes information about hydatid disease (echinococcosis), which is caused by the larval stage of the tapeworm Echinococcus. It is most prevalent in rural areas where older animals are slaughtered. The life cycle involves canines as the definitive host and sheep as the intermediate host. Humans can become accidentally infected through contact with infected animal feces. Clinically, hydatid cysts most commonly form in the liver and lungs, though any organ can be affected. Diagnosis involves imaging like ultrasound or CT scan along with serological tests. Treatment options include surgery, anthelmintic drugs like albendazole, and percutaneous drainage of cysts. Follow up involves monitoring for
This document summarizes a seminar on choledochal cysts. It discusses the presentation, incidence, classification, investigations, complications and management of choledochal cysts. The key points are:
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Hydatid cysts are most commonly found in the liver and lungs, although they may also occur in other organs, bones and muscles. The cysts can increase in size to 5 – 10 cm or more and may survive for decades. Non-specific signs include loss of appetite, weight loss and weakness
Echinococcus granulosus sensu lato occurs practically worldwide, and more frequently in rural, grazing areas where dogs ingest organs from
diagnosis
epidemiology
managment
1) The document discusses different types of liver infections including pyogenic liver abscess, amoebic liver abscess, and hydatid cyst of the liver.
2) Pyogenic liver abscess is usually caused by bacteria entering through the gastrointestinal tract or biliary system. It can be treated with antibiotics or drainage procedures.
3) Amoebic liver abscess is caused by Entamoeba histolytica and presents as a tender hepatomegaly. Ultrasound or CT guided aspiration is usually done along with antimicrobial therapy.
4) Hydatid cyst is a parasitic infection caused by Echinococcus granulosus transmitted by dogs. It appears as cysts
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1. RECENT TRENDS IN DIAGNOSIS
AND MANAGEMENT OF HEPATIC
HYDATID DISEASE
Presenter: Dr. Archit Gupta
Moderator: Prof. R.S. Jhobta
Asstt.Prof. Jagdish Kumar Gupta
Dept.of Surgery IGMC Shimla
2. INTRODUCTION
• Hepatic hydatid was known to Hippocrates, who described it as
“livers full of water.”
• In present century, significant advances have been made in the
accurate diagnosis and effective treatment of hydatid disease
• After the World War 2, enormous advances were achieved in
• Surgical Techniques
• Organ Imaging Techniques and
• Immunologic Diagnosis
• The stage has been reached when the diagnosis and treatment of human
hydatid disease is at a most effective and sophisticated level resulting in
decreased morbidity and mortality rate.
3. INTRODUCTION
• Hydatid disease is a zoonosis caused by larval stage of Echinococcus
granulosus (also known as taenia echinococcus).
• The word echinococcus is of Greek origin and means “hedgehog
berry.”
• Hydatid is also of Greek origin (hudatid, hudatis) and means a “watery
vesicle
• In humans, 50-75% of the cysts occur in the liver, 25% are located in
lungs and 5-10% distribute along arterial system.
4. HISTORY
• The first case was observed in 1808 and published in 1822.
• The life cycle was first elucidated by Haubner in 1855
• The true nature of the disease was not known until the second half of the
nineteenth century.
• Successful results of chemotherapy in hepatic hydatid were reported in 1977.
• PAIR was proposed in 1986
• WHO classification of hydatid cyst was given in 2001
• WHO-IWGE guidelines 2009 proposed an image based approach for
management of hydatid cyst
5. Causative Organisms
• E. granulosus - produces unilocular cystic lesions
• E. multilocularis - causes multilocular alveolar lesions that are locally invasive
• E. vogeli - causes polycystic hydatid disease
• E. oligarthus – not much known. Causes polycystic echinococcus.
7. Pathogenesis
Primary cyst in the liver is composed of three layers:
1. Adventitia (Pseudocyst / Pericyst) –
• Compressed liver parenchyma and fibrous tissue induced by the expanding parasitic cyst.
• Pericyst acts as a mechanical support for hydatid cyst and is metabolic interface between the
host and the parasite.
2. Laminated membrane (Ectocyst) –
• Bluish white, gelatinous, about 0.5cm thick
• It is a cuticular chitinous structure without nuclei
• Acts as a barrier for bacteria and an ultrafilter for protein molecules.
3. Germinal epithelium (Endocyst) –
• Single layer of cells lining the inner aspects of the cyst and is the only living component
• Responsible for the formation of the other layers as well as the hydatid fluid and brood
capsules within the cyst
8. Hydatid Sand
• Brood capsule and freed protoscoleces are released into the fluid of the
original cyst and together with calcareous bodies form hydatid sand
• Hydatid sand is made of around 400,000 scolices /ml of fluid
Cyst Growth
• Cysts in liver grow to 1cm in first 6 months and 2-3cm annually thereafter
• Development of brood capsule from the germinal layer indicates complete
biologic development of the cyst, which occurs after 6 months of growth
9. Epidemiology
• Echinococcosis occurs worldwide and is endemic in some countries
such as Australia and the Middle East, especially in sheep farming
areas.
• In endemic areas, the annual incidence of cystic echinococcosis
ranges from 1 to 200 per 100,000 inhabitants.
• In India, hydatid is reported from practically all parts of the country
• Higher incidence is reported from Tamil Nadu and Andhra Pradesh,
particularly from Madurai district.
10. Clinical features
• Male = female (Avg age 45 yrs)
• Approx 70% located in the right liver and are solitary
• Most common segment- segment VII (27%)
• Both lobes 16% and only left lobe 17%
• Cysts are largely asymptomatic until complications occur
• Symptoms of hydatid disease may be caused by compression, obstruction, or
displacement of adjacent organs or structures
• The most common presenting symptoms are abdominal pain, dyspepsia and vomiting
• May present as obstructive Jaundice (intrahepatic biliary obstuction)
• Specially in children- chronic pain abdomen, wt loss and wasting
11. Clinical signs
• Hepatomegaly (most common)
• Palpable RUQ mass(cystic)
• Mass with Hydatid thrill (elicited by three-finger test)
• Cachexia in children
• Camellotte sign: Following intrabiliary rupture – partial collapse of the cyst wall.
Enlarged palpable liver due to
hydatid with positive hydatid thrill
12. CASE DEFINITIONS
Possible case
• Any patient with a clinical or epidemiological history
• Imaging findings or Serology positive for CE
Probable case.
• Any patient with the combination of clinical history, epidemiological history, imaging findings and
serology positive for CE on two tests.
Confirmed case.
• The above, plus either
(1) Demonstration of protoscoleces or their components, using direct microscopy or molecular
biology, in the cyst contents aspirated by percutaneous puncture or at surgery
(2) Changes in US appearance, e. g. detachment of the endocyst in a CE1 cyst, thus moving to a
CE3a stage, or solidification of a CE2 or CE3b, thus changing to a CE4 stage, after
administration of ABZ (at least 3 months) or spontaneous.
Brunetti et al. / Acta Tropica 114 (2010) 1–16
13. Laboratory Findings
• Routine haematological tests may reveal eosinophilia
• Casoni’s intradermal test – due to its low sensitivity and specificity and because of risk of
causing anaphylactic reactions, it is obsolete now.
• Serological tests detect specific antibodies to the parasite and are the most commonly
employed tools to diagnose past and recent infection with E. granulosus.
• Detection of IgG antibodies implies exposure to the parasite, while in active infection
high titers of specific IgM and IgA antibodies are observed.
• Detection of circulating hydatid antigen in the serum is of use in monitoring after
surgery and pharmacotherapy and in prognosis.
14. Serological Tests
• Indirect Haemagglutinin Test (IHA)
• Complement Fixation Test (CFT)
• Latex Agglutination Test (LT)
• Indirect Flourescent Antiody test (IFAT)
• Immunoelectrophoresis (IEP)
• Counterimmune Elecctrophoresis (CIE)
• Double diffusion test (DD)
• ELISA
• Radioallergosorbent test (RAST)
• Basophil degranulation test (BDT)
• For an individual patient, stratergy should be initial screening with high sensitivity test like IHA or LT,
followed by confirmation with highly specific test like IEP, DD, ELISA OR RAST.
• The only serological test that has a role in monitoring progress after surgery for hydatid is CFT because it
reverts to negative within 12 months of cure.
• Recently, reports have suggested that BDT has a high sensitivity and that it becomes negative within a week
of cure.
16. Ultrasound
• Initial imaging test of choice
• Role of ultrasound in hydatid disease includes:
a. Screening in endemic areas
b. First line diagnostics
c. Interventional non operative procedures
d. Intraoperative ultrasound
e. Monitoring treatment and during follow up
• In 1984 Hassen A. Gharbi gave a classification based on ultrasound
findings of hydatid cyst, which was modified by WHO in 2001.
17. Gharbi’s Classification
• Type I : pure cystic fluid Collection
(spherical-oval, thick-walled)
• Type II : fluid Collection with
membrane separation
• Type III : Fluid collection with septa
• Type IV: heterogeneous
(hypoechoic-hyperechoic-
intermediate) pattern
• Type V: completely calcified
(Reflecting) walls
18. USG Classification (WHO-IWGE, 2001)
Group 1 : Active group –
• Cysts larger than 2 cm and fertile (CE1, CE2)
Group 2 : Transition group –
• Cysts starting to degenerate and entering a transitional stage because of host resistance or treatment,
but may contain viable protoscolices (CE3)
Group 3 : Inactive group –
• Degenerated, partially or totally calcified cysts, unlikely to contain viable protoscolices. (CE4,CE5)
18
21. CE2
- Cyst with multiple septations
giving it multivesicular
appearance or rossette
appearance or honey comb
appearance with unilocular
mother cyst
22. CE3
• Unilocular cyst with daughter
cysts with detached laminated
membranes appearing as water
lily sign
• CE3 transitional cysts may be
differentiated into
• CE3a (with detached endocyst)
• CE3b (predominantly solid with
daughter vesicles)
23. CE4
Mixed hypo and hyperechoic contents
with absent daughter cysts
These contents give an appearance of
Ball of wool sign (indicating the
degenerative nature of the cyst)
25. CECT Abdomen
• CT gives similar information to ultrasound, but more specific
information about the location and depth of cyst within the liver.
• Daughter cysts and exogenous cysts are also clearly visualised and
cyst volume can be estimated.
• CT is imperative for operative management especially when
laparoscopic approach is used.
26. CECT abdomen showing a large univesicular
cyst.
CECT abdomen showing a large cyst full of daughter
cysts (multivesicular, rosettelike)
27. CT scan showing hydatid cyst in left lobe of liver with
periphery showing double edge s/o lamellar membrane
CT scan showing a round lesion with water
attenuation and a ringlike pattern of calcification.
This pattern represents calcification of the pericyst
28. MRI
• MRI provides excellent structural detail of hydatid cysts and is superior to CT
in demonstrating alteration of the hepatic venous system.
• MRI and magnetic resonance cholangiopancreatography (MRCP) is suggested
in
(a) Subdiaphragmatic site of HC
(b) Disseminated disease
(c) Extra-abdominal location
(d) Complicated, symptomatic, cysts
(e) Pre-surgical evaluation and planning (liquid areas and structure of the HC).
• MRCP is an excellent noninvasive tool for investigating jaundiced patients
with liver hydatidosis
29. T2 weighted coronal MRI showing multiple daughter cysts MRCP showing large hydatid cyst with daughter cysts
communicating with common bile duct
30. ERCP
• ERCP has little value in asymptomatic patients and should be avoided
• ERCP is indicated when there is suspicion of daughter cysts in the
biliary tree causing obstructive jaundice
• Indications for endoscopic papillotomy in the preoperative period are
• when US, CT, MRCP, or ERCP detect hydatid material in the CBD
• when cholangitis has been a feature of the clinical presentation
• Critical use of ERCP and papillotomy in patients with cystobiliary
communications has reduced mortality and in-hospital stay
32. TREATMENT
Modalities of treatment of hydatid cyst include
1. Chemotherapy
2. PAIR and other percutaneous treatments
3. Open Surgery
4. Laparoscopic Surgery
• In 2009, WHO –IWGE proposed an image based approach for
management of hydatid cyst.
33. <5 cm – Albendazole
>5 cm – PAIR and
Albendazole
Surgery
Other percutaneous
treats can be used
3a 3b
<5 cm - ABZ
>5 cm – PAIR
and ABZ
Surgery
Wait and
Watch
Wait and
Watch
WHO guidelines for management of hydatid cyst, 2010
34. CHEMOTHERAPY
Albendazole – drug of choice
Mechanism of action : Metabolite of albendazole in liver, albendazole
sulfoxide is active against protoscoleces of echinococcus granulosus .
Dosage: 10 to 15 mg/kg/d, in two divided doses, with a fat rich meal
Duration of therapy: For patients being managed conservatively : to be given
for 3 months
Pre-interventional: 4 days before intervention and to be continued till 1
month after intervention.
It should be administered continuously, without the monthly treatment
interruptions (recommended in the 1980s).
Side effects: Pancytopenia, aplastic anemia, agranulocytosis, leucopenia
35. CHEMOTHERAPY
Praziquantel
• A synthetic isoquinoline pyrazine derivative
• Increases the protoscolicidal effect of albendazole
• Dosage: 40 mg/kg once a week in combination with albendazole
36. Indications of chemotherapy
(a) Inoperable patients with primary liver cystic echinococcosis
(b) Patients with multiple cysts in two or more organs
(c) Multiple small (5 cm, CE1 and CE3) liver cysts
(d) Cysts deep in liver parenchyma
(e) Prevention and management of secondary hydatidosis
(f) Management of recurrent hydatidosis
(g) Unilocular cysts in unfit elderly patients
(h) In combination with surgery and interventional procedure
37. Contraindications of Chemotherapy
(a) Large cysts (10 cm)
(b) Cysts with multiple septa divisions (honeycomblike cysts)
(c) Cysts that are prone to rupture (superficial)
(d) Infected cysts
(e) Inactive cysts
(f) Asymptomatic calcified cysts
(g) Severe chronic hepatic disease
(h) Bone marrow depression
(i) Early pregnancy
• Diabetes is a relative contraindication
38. PAIR
•PAIR Protocol (Minimum Requirements):
1. Puncture and parasitological examination (if possible) or fast test for
antigen detection in cyst fluid
2. Aspiration of cystic fluid (10-15 cc)
Test for bilirubin in cyst fluid
If bilirubin present: →→ →→ stop procedure
If no bilirubin present: →→ →→ aspirate all cystic fluid
3. Injection of 95 % ethanol solution or hypertonic saline (1/3 of the
amount
of aspirated fluid)
4. Re aspiration of protoscolicide solution after 15 minutes
39.
40. Indications for PAIR
• Inoperable patients
• Patients who refuse surgery
• Cysts types CL, CE1, CE3a
• Relapse after surgery
• Infected cysts
• Failure of chemotherapy,
• Multiple cysts of more than 5-cm diameter in different liver segments
• Pregnant women (chemotherapy contraindicated)
• Children less than 3 years old.
41. Contraindications for PAIR
• Inaccessible cysts
• Superficially located cysts
• Cysts with multiple septa divisions (honeycomblike cysts CE2, CE3b)
• Cysts with hyperechogenic solid patterns (CE4)
• Cysts communicating with bile ducts
• Partially or totally calcified cysts (CE5)
42. Modifications of PAIR
Complicated cysts, cysts with many daughter cysts, or large-volume
cysts are indications for PAIR modifications:
1. The PAIR-catheterization technique
2. The D-PAI (doublepuncture, aspiration, and injection) technique
3. The percutaneous evacuation of cyst content (PEVAC) technique
4. The modified catheter aspiration technique (MoCAT)
43. Surgery in Hepatic Hydatid Disease
• The classic open surgical procedures can be subdivided into two groups:
Conservative
• Tissue-sparing procedures that are limited to removing the parasite, with part or
most of the pericyst left in situ
Radical
• Resectional procedures that remove the entire pericyst, with or without entering the
cyst itself.
The choice of the surgical techniques depends on
• Type and size of the cyst
• Site
• Presence of complications
• Expertise of the surgeon.
44. Principles of Hydatid Surgery
• Total removal of all infective components of the cysts
• The avoidance of spillage of cyst contents at time of surgery
• Management of communication between cyst and adjacent
structures
• Management of the residual cavity
• Minimize risks of operation
45. Indications for open surgery
• Large cysts with multiple daughter cysts type (CE2, CE3b)
• Single liver cysts situated superficially that may rupture
• Infected cysts
• Cysts with cystobiliary communication
• Cysts exerting pressure on adjacent organs
46. Contraindications for surgery
• Patients refusing surgery
• Extreme age
• Pregnant women
• Concomitant severe diseases
• Numerous cysts
• Cysts difficult to access
• Dead cysts
• Cysts partially or totally calcified
• Very small cysts (<5 cm)
47. Conservative Technique ( Open Cystectomy)
• Safe decompression of cyst is importrant
• All cysts should be treated as if they are vital and infectious
• The entire area around the mobilized liver is packed with blue or green packs
and drapes are soaked in 15% - 20% saline.
• The point where the cyst is to be punctured is determined and a working
area, as small as possible, is delineated by additional packing.
• This is important because the high intracystic pressure makes it difficult to avoid some
leakage of cyst contents.
• The cyst is then opened and the contents are aspirated with a suction device
• Special devices have been designed for safe decompression of HCs.
• The use of “cones” (adhere to liver surface by freezing or vacuum)
• The cavity is then irrigated with a scolicidal agent
48.
49. Aaron Cryogenic Cones
• The cryogenic cone is a funnel-shaped appliance with the narrow end chopped off
midway.
• A coiled tube is soldered to the base of the cone.
• The cone can be frozen and fixed on to the surface of the liver over a hydatid cyst by the
passage of liquid nitrogen through the tube.
• The hydatid cyst can then be opened without any danger of spillage and seeding of
daughter cysts into the abdominal cavity
51. Management of Residual Pericyst Cavity
• Marsupialization
• Deroofing
• Omentoplasty
• Interoflexon
• Cappitonage
• Drainage of cyst
52. Techniques for the management of the residual cavity. A: Cyst with
oversewn rim left open. B: Introflexion - infolding of the rim of the
pericyst cavity. Suture does not engage the bottom of the cavity. C:
Capitonnage with drainage. There is spiral suturing from the bottom of
the cavity upward. D: Omentoplasty.
53. Radical surgical procedures
Radical surgical procedures include
• Pericystectomy
• Lobectomy
• Hepatectomy
• Radical procedures have lower rate of complications and recurrences
• Many authors consider them inappropriate, claiming that intraoperative
risks are too high for a benign disease.
Fethi Derbel, Mohamed Ben Mabrouk, et al. (2012). Hydatid Cysts of the Liver - Diagnosis, Complications and Treatment, Abdominal Surgery, Prof. Fethi Derbel (Ed.), InTech, DOI: 10.5772/48433.
54. Pericystectomy
• This procedure involves a non-anatomical resection of
cyst and surrounding compressed liver tissue.
• This is technically a more difficult procedure than
cystectomy and can be associated with considerable
blood loss
• It can also be hazardous in the case of large and
complicated cysts when the cyst distorts vital anatomical
structures such as; hepatic veins or biliary ducts.
Fethi Derbel, Mohamed Ben Mabrouk, et al. (2012). Hydatid Cysts of the Liver - Diagnosis, Complications and Treatment, Abdominal Surgery, Prof. Fethi Derbel (Ed.), InTech, DOI: 10.5772/48433.
55. Rationale for Radical Procedures
• Total removal of the cyst and exocysts is associated with the lowest
recurrence rate
• Chemotherapy after radical removal of the intact cyst is unnecessary
• The use of intraoperative protoscolicidal agents is unnecessary if the
cyst is not entered
• The chance for a biliary fistula and cavity- related complications is low
• Calcified cysts can be removed
• In expert hands the mortality and morbidity rates are low.
56. Laparoscopic Surgery
• The rapid development of laparoscopic techniques has encouraged
surgeons to replicate principles of conventional hydatid surgery using
a minimally invasive approach.
• It offers a lower morbidity outcome and a shorter hospital stay
• Gives a better visual control of the cyst cavity under magnification
which allows a better detection of biliary fistula.
• Different instruments have been described to try to avoid leakage of
daughter cysts and scolices which include the Palanivelu hydatid
system and the perforator grinder aspirator apparatus.
58. The criteria to exclude laparoscopic treatment of hydatid cyst of liver
are:
Cystobiliary communication (on imaging)
Central localization of the cyst
Cysts dimension >15 cm
Number of cysts > 3
Thickened or calcified walls
Opening of bile ducts that leak bile
59. Trocar placement based on
baseball diamond concept.
Aspiration of cyst contents and injection of hypertonic saline
to create a negative balance
61. Complications of surgery
• Biliary leakage is the most frequent complication
• Although most of the external biliary fistulas close spontaneously, they may be persistent in 4%-27.5% of
the cases.
• Endoscopic sphincterotomy is performed after a 3-weeks in patients with low-output fistulas
• Can be performed earlier in patients with high-output fistulas.
• Infection of the residual cavity
• More frequent when the pericyst is thick and calcified.
• Needs reoperation or percutaneous drainage under CT-scan guidance.
• Mortality:
• 0.9 -3.6 %.
• Recurrence rate
• Varies with type of surgery
• Up to 11.3 % within 5 years.
62. ?Best for management of residual cyst cavity
• According to the RCT by Dziri et al omentoplasty alone leads to fewer
complications.
Dziri C, Haouet K, Fingerhut A. Treatment of hydatid cyst of the liver: where is the evidence? World J Surg
2004; 28:731-736
63. RADICAL OR CONSERVATIVE SURGICAL
TREATMENT?
• A comparative retrospective study of 242 patients described significantly higher
morbidity and recurrence rates in patients who underwent conservative surgery
(11% vs 3%; 24% vs 3%)
Aydin et al , J Gastroenterol 2008
• Randomized study involving 32 patients, compared radical surgery and
conservative surgery. The authors concluded that conservative surgery leads to a
significantly higher early recurrence rate (P = 0.045) compared to radical surgery,
as well as a higher rate of complications in the residual cyst cavity (P = 0.011)
Yüksel O, J Gastrointest Surg 2008
64. Complications of hydatid cyst of the liver:
• Echinococcal cysts of the liver can cause complications in about 40% of cases.
• The most common complications in order of frequency are
• Infection
• Intrabiliary rupture of hydatid cyst
• The rupture in the thorax
• The rupture in the peritoneum
Fethi Derbel, Mohamed Ben Mabrouk, et al. (2012). Hydatid Cysts of the Liver - Diagnosis, Complications and Treatment, Abdominal Surgery, Prof. Fethi Derbel (Ed.), InTech, DOI: 10.5772/48433.
65. Treatment of hydatid cysts rupture into the biliary
tracts
• There are two different clinical settings associated with intrabiliary rupture
• Frank intrabiliary rupture - the cyst content drains to biliary tract and causes cholestatic jaundice
• Simple communication - simple communications can cause post-operative biliary fistulae.
• If the diameter of communication is larger than 5 mm, cystic content migration into the biliary tract
will occur in 65% of the cases.
• Vesicles, debris and purulent materials may be found in the biliary ducts.
• Surgery must be done early.
• Delay can cause suppurative cholangitis, septicemia and liver abscess formation.
66. Treatment of hydatid cysts rupture into the
biliary tracts
• In bile leakage cases, peroperative cholangiography can be done
• The injection of radiopaque solution or methylene blue is helpful to diagnose intrabiliary
rupture or to see the orifice.
67. • The treatment of the cysto-biliary communication is based on several techniques:
Suture of the communication
• Simple suture
• Suture with T-tube CBD drainage
Internal drainage procedures
• Biliodigestive bypass
• Transduodenal sphincterotomy
• Internal transfistular drainage with or without transduodenal sphincteroplasty
External drainage procedures
Reconstructive procedures
• Pericystojejunostomy
• Intracavitary biliodigestive bypass
• Bile duct repair
Liver resection
68. Post-operative cholangiography in a patient treated for hydatid cyst with large bilio-
cystic fistula treated with partial cystectomy and T tube drainage.
69. Follow Up
• Chemotherapy:
• Postoperative treatment with benzimidazoles for 1 month who have
undergone cystectomy or PAIR successfully.
• Continued for 3-6 months for patients, incompletely resected cyst,
spillage during surgery.
70. Follow Up
• Laboratory tests:
• Patients on benzimidazoles should have a CBC count and liver enzyme
evaluation performed at biweekly intervals for 3 months and then
every 4 weeks to monitor for toxicity.
• ELISA or indirect hemagglutination tests are usually performed at 3-,
6-, 12-, and 24-month intervals as screening for recurrence.
• Imaging: Ultrasonography or CT scan at the same intervals as the
laboratory tests or as clinically indicated
71. Prevention
• Public education about the life cycle and transmission of the disease
• Washing hands after contact with canines
• Eliminating the consumption of vegetables grown at ground level from the diet
• Stopping the practice of feeding entrails of slaughtered animals to dogs
72. Conclusion
• Hydatid disease remains a continuous public health problem in endemic countries.
• The liver is the most common site for hydatid disease, followed by the lungs (15%), the
spleen (5%), and other organs (5%).
• Diagnosis of liver hydatid disease is made with Ultrasonography and computed
tomography.
• Surgery combined with medical treatment by albendazole is effective in the eradication of
hepatic hydatid disease and in the prevention of local recurrences.
• Although surgery is the recommended treatment for liver hydatid disease, percutaneous
treatment has been introduced as an alternative to surgery.
• PAIR is a valuable alternative to surgery. It is safe and efficient in selected patients
73. Sources
• WHO-IWGE Guidelines on management of Cystic Echinococcosis, 2009
• Maingot Abdominal Operations, 9th & 12th Edition
• Mastery of Surgery, 6th Edition
• Art of Laparoscopic Surgery by C. Palanivelu, 1st Edition
• Bailey & Love’s Short Practice of Surgery, 26th Edition
The cyst is punctured with a laparoscopic needle and hypertonic saline is put and aspirated from the cyst. This is done to replace the cyst contents with hypertonic saline.