hydatid cyst of liver

1. HYDATID DISEASE OF LIVER
PRESENTER- Dr. Bashab Bijoy Roy
MODERATOR- Dr. R.C.Shyam
(Asst. Proff)

3. History
• This disease has been known since earliest times. It was
called by Hippocrates as “Livers full of water”.
• The word “Echinococcus”is of Greek origin which
means “Hedgehog berry”.
• The word Hydatid means “drop of water” or a “watery
vesicle”.
• In 1760 Pallas & Goeze demonstrated the parasitic
nature of “watery cysts” in animals.
• The name Echinococcus was first used by Rudolphi,
who demonstrated the presence of the Cestode ,its
head, suckers & hooklets in hydaitd cyst in humans.

4. Epidemology
• E. Granulosus is present virtually world-wide,more
common in sheep & cattle raising countries.

9. Life cycle of a dog tapeworm

15. Pathology
• The oncosphere after reaching the target organ (mainly
liver), faces a cellular response of the host tissue.
• Host tissue respone-covers the parasite in fibrous tissue-
forming the PERICYST.
• If the parasite survives the host defence mechanism ,in 5 -7
days the larva develops a 6-7 mm vesicle,
with 2 distinct layers-
A)Outer protective laminated membrane- The ECTOCYST
B) Inner germinal layer- The ENDOCYST
• After 21 days the cyst is visible to naked eyes.
• In 3 months it can measure upto 3-5 cm in diameter

20. • A typical hydatid cyst in unilocular,mainly involves
segment 7 & 8 of the liver.
• Rate of increase in size is about 1 to 1.5mm in
diameter per month.
• Intracystic fluid is under pressure of 30-70cm H₂O.
• Hydatid fluid is antigenic in property.
• Sudden rupture of cyst can be life threatening-
symptoms of allergic reactions range from skin
rash to severe anaphylactic reaction.
• This antigenicity of hydatid fluid is the basis of
serodiagnostics.

24. Daignosis
• A proper history of contact with canines.
• High index of suspicion in endemic areas.
• Routine hematology- elevated TLC, eosinophilia
• LFT- elevated bilirubin & raised liver enzymes.
• Serodignostic test- ELISA & Indirect hemagglutination
test -high sensitivity (90%) & are intial screening test of
choice.
• Immuno-diffusion & immuno-electrophoresis-
demonstrate antibodies to antigen 5 ,are specific
confirmation of reactivity.
• Casoni’s intradermal test-low sensitivity & specificity,
risk of anaphylactic reaction. It is obsolete now.

25. Imaging

35. CT-SCAN

41.  Cysts deep in liver parenchyma
 Prevention & management of secondary hydatidosis
 Cyst of size <5cm
Indications of medical therapy

45. Types of surgery
1. Conservative surgery- Partial pericystectomy.
2. Radical surgery-
Open /closed cystectomy
Total pericystectomy
Near total cystectomy
Sub-adventitial cystectomy
Complete cystectopericystectomy.
Liver resections- anatomical / non-anatomical.

46. Principles of Conservative surgery
• Safe & complete exposure of cyst.
• Safe decompression of the cyst.
• Safe evacuation of the cyst contents.
• Sterilization of the cyst.
• Management of cysto-billiary communication,when
present.
• Management of the residual cyst cavity.

47. Conservative surgery

48. Use of coloured Mops ;
Pearly white daughter
cysts
Large right lobe
hydatid cyst

50. Management of the residual cystic cavity
Simple cyst closure

53. Principle of radical surgery
• Total removal of cyst with exocysyt
• Associated with lowest recurrence rate
• Intra-operative proctoscolicidal agent is not
necessary if cyst is not entered
• Chemotherapy after intact cyst removal is not
necessary
• Chance of biliary fistula & cavity related
complication is low.

54. Radical surgery

56. Laparoscopic approach- Palanivelu hydatid system
Dr. C. Palanivelu

60. Isolation of operative field

63. Per-cutaneous treatments
1. PAIR- puncture aspiration injection re-aspiration
2. PAIR Catherization.
3. PEVAC( puncture & evacuation of cyst)

66. •Prophylactic Albendazole dose to be given.

69. Limitation of pair:
•In this method , the daughter cysts & laminated membranes
remain inside the cavity
• Each daughter cyst must be puncteured separately, which is
very difficult.
Complications of PAIR:-
1. Utricaria
2. Anaphylaxis
3. Fever
4. Biliary fistula
5. Secondary infection of cyst cavity
6. Hypotension/ hypotensive shock.
Overall complication rate is 10- 40%.
Mortality rate 0.9 – 2.5%
Local recurrance – 4%

72. Complications of Hydatid cyst if left untreated