This research article studied preoperative predictive factors of occult and frank intrabiliary rupture of liver hydatid cysts. The study reviewed 56 patients with 82 liver hydatid cysts who underwent surgery. Cysts were divided into three groups: no rupture, occult rupture with bile in cyst but no passage into bile duct, and frank rupture with passage into bile duct. Multivariate analysis identified jaundice, cyst size >6.5cm, and symptoms >45 days as predictors of frank rupture. Predictors of occult rupture included cyst size >6.5cm, ≥3 recurrences, type II/III cyst, leukocytosis >9,000/mm3, and eosinophilia >5.5
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
A Retrospective Analysis of Complications of Pelvic Exenteration - A Single I...Premier Publishers
To analyse complications in patients who underwent pelvic exenteration procedures performed in our, between January 2013 – December 2018. A retrospective analysis of the baseline characteristics, surgical outcomes, complication rates of 51 patients who had undergone pelvic exenteration procedures between January 2013 and December 2018 was made. The results analysed using chi-square test. Of the 51 patients, 38 were operated for primary malignancy and 13 underwent exenteration for recurrences. Seventeen patients were operated by laparoscopy whereas the rest underwent open procedures. The diagnosis for which exenteration had been done included cancers of cervix (37), urinary bladder (5), rectum (4), urethra (1), vagina (3), and ovary (1). Bleeding was the most common complication encountered. Hypokalaemia, surgical site infections, urine leak and sepsis were seen in early post-operative period. The morbidity rate (major) was 33.3% and the mortality rate was 5.8% in our centre. The late outcome was inadequately evaluated as most patients lost follow-up. Pelvic exenteration is the only surgical option available for advanced pelvic malignancies and the morbidity pattern differs based on diagnosis, extent of resection and the type of diversion procedure. In a high-volume centre, the morbidity and mortality rates are acceptable compared with international standards.
Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an AdultKETAN VAGHOLKAR
Introduction: Colocolic intussusception in adults is uncommon and poses both a diagnostic
and therapeutic dilemma. The association of an underlying malignancy necessitates a preoperative
confirmation of diagnosis. The presenting features are variable. Hence contrast enhanced
computed tomography of the abdomen is pivotal for diagnosis. An en bloc resection
of the specimen in accordance with standard oncological principles is the mainstay of treatment.
Case report: A case of colocolic intussusception in an adult is presented to highlight the
difficulties in preoperative diagnosis and in selecting the best surgical option for treatment.
Conclusion: Adult bowel intussusception is a diagnostic dilemma with preoperative diagnosis
being the biggest challenge. CT scan of the abdomen is an excellent diagnostic modality with
high diagnostic accuracy. Explorative laparotomy with en bloc resection is mainstay of treatment
in adults.
Background: The incidence of abdominal tuberculosis is increasing. Preoperative diagnosis continues to
be the biggest challenge. Diagnosis is established only after histopathological examination. The modes of presentation
and therapeutic options need to be assessed. Objectives: To study the patterns of presentations, the extent of organ
involvement and therapeutic options. Materials and methods: Fifty histopathologically proven cases of abdominal
tuberculosis were studied. In addition, epidemiologic data, clinical patterns of presentation, diagnostic and various
surgical options, including outcomes, were studied. Results: The mortality in the study was 8%. The disease was
commonly seen in 21 to 40 years old and commonly seen in females. HIV positivity, anaemia and hypoproteinaemia
were associated with poor outcomes. Four types of presentations were observed. Diagnostic laparoscopy enabled early
histopathological diagnosis of biopsy specimens. Chemotherapy is the mainstay of treatment Surgery is a significant
adjunct in diagnosing and managing complications. Patients presenting with perforative peritonitis had a poor prognosis
Conclusion: Critical evaluation of chronic abdominal pain is essential. Supportive evidence such as the history of TB or
contact with a patient suffering from TB is highly suggestive of abdominal tuberculosis. Radiological tests are highly
suggestive but not diagnostic. Diagnostic laparoscopy enables tissue diagnosis. Chemotherapy accompanied by surgical
intervention for complications is the mainstay of treatment.
A Retrospective Analysis of Complications of Pelvic Exenteration - A Single I...Premier Publishers
To analyse complications in patients who underwent pelvic exenteration procedures performed in our, between January 2013 – December 2018. A retrospective analysis of the baseline characteristics, surgical outcomes, complication rates of 51 patients who had undergone pelvic exenteration procedures between January 2013 and December 2018 was made. The results analysed using chi-square test. Of the 51 patients, 38 were operated for primary malignancy and 13 underwent exenteration for recurrences. Seventeen patients were operated by laparoscopy whereas the rest underwent open procedures. The diagnosis for which exenteration had been done included cancers of cervix (37), urinary bladder (5), rectum (4), urethra (1), vagina (3), and ovary (1). Bleeding was the most common complication encountered. Hypokalaemia, surgical site infections, urine leak and sepsis were seen in early post-operative period. The morbidity rate (major) was 33.3% and the mortality rate was 5.8% in our centre. The late outcome was inadequately evaluated as most patients lost follow-up. Pelvic exenteration is the only surgical option available for advanced pelvic malignancies and the morbidity pattern differs based on diagnosis, extent of resection and the type of diversion procedure. In a high-volume centre, the morbidity and mortality rates are acceptable compared with international standards.
Pedunculated Lipoma of the Caecum Causing Colocolic Intussusception in an AdultKETAN VAGHOLKAR
Introduction: Colocolic intussusception in adults is uncommon and poses both a diagnostic
and therapeutic dilemma. The association of an underlying malignancy necessitates a preoperative
confirmation of diagnosis. The presenting features are variable. Hence contrast enhanced
computed tomography of the abdomen is pivotal for diagnosis. An en bloc resection
of the specimen in accordance with standard oncological principles is the mainstay of treatment.
Case report: A case of colocolic intussusception in an adult is presented to highlight the
difficulties in preoperative diagnosis and in selecting the best surgical option for treatment.
Conclusion: Adult bowel intussusception is a diagnostic dilemma with preoperative diagnosis
being the biggest challenge. CT scan of the abdomen is an excellent diagnostic modality with
high diagnostic accuracy. Explorative laparotomy with en bloc resection is mainstay of treatment
in adults.
A Rare Case of Choledochal Cyst Connecting Intra- And ExtraHepatic Ductsemualkaira
Choledochal cysts are rare congenital dilatations of the
extra and/or intrahepatic bile ducts found primarily in children
and estimated of much higher incidence in Asia, where it reaches
approximated 1:1000, as compared to Western population [1,2].
A choledochal cyst increases the risk of malignant transformation up to 10% and patients may still be exposed at higher risk for
biliary malignancies even after surgical resection
Cystitis Glandularis: A Case Report of a Rare Benign Bladder Tumorsemualkaira
Pseudotumor or florid cystitis glandularis is the bladder urothelial
of the which mainly affects humans [1,2,3].
It is facilitated by chronic and recurrent irritation of the bladder.
Because of its non-specific symptoms, it poses a diagnostic problem with malignant bladder tumors [4]. We report 1 case of cystitis
glandularis. In the light of this case, we will discuss the diagnostic
and therapeutic aspects as well as the prognosis of this condition
Cystitis glandularis : a case report of a benign bladder tumorkomalicarol
Pseudotumor or florid cystitis glandularis is the bladder urothelial
of the which mainly affects humans [1,2,3].
It is facilitated by chronic and recurrent irritation of the bladder.
Because of its non-specific symptoms, it poses a diagnostic problem with malignant bladder tumors [4]. We report 1 case of cystitis
glandularis. In the light of this case, we will discuss the diagnostic
and therapeutic aspects as well as the prognosis of this condition
Surgical management of hepatic hydatid diseaseKETAN VAGHOLKAR
Hydatidosis is strictly a zoonosis. Humans are an accidental host. The disease is endemic in rural agricultural areas. However if acquired by humans, it can cause extensive spread affecting a wide range of organs with predilection for the liver. Managing such cases requires a sound fundamental knowledge of the parasite and its pathogenicity. It is essential that surgeons who deal with such cases have a good working knowledge of the disease. The approaches to hepatic hydatids with respect to the principles of surgical treatment are presented in this article.
Rupture of a Hydatid Cyst into the Bile Ductasclepiuspdfs
Cholestasis secondary to a cystobiliary communication is a rare complication associated with hepatic hydatidosis. The most established surgical procedure is the evacuation of the contents of the cyst (daughter cysts) without spills, sterilization of the cyst cavity with scolicide agents to prevent the dissemination of the hydatids to the peritoneal cavity, and cavity management (capitonnage) together with the closing of the communication.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Abstract
This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.
Solitary retroperitoneal hydatid cyst masquerading as pseudocyst of pancreasDrKetanVagholkar
Primary retroperitoneal hydatid cyst is a rarity. Literature on this topic is sparse with anecdotal case reports. Hence
the condition poses both a diagnostic and therapeutic dilemma to the attending surgeon. The objective of reporting
this case is to highlight the challenges faced by the surgeon in diagnosing and treating this uncommon entity. A 70-
year-old man presented with epigastric pain and discomfort accompanied by abdominal mass extending over the
epigastric and right hypochondriac region. CECT revealed a cystic lesion in the retroperitoneal, peripancreatic region.
The cystic lesion was diagnosed as a primary retroperitoneal hydatid cyst at the time of surgical intervention. Partial
cystectomy was performed due to dense adhesions between head of pancreas and the cyst wall. A high index of
suspicion for a primary retroperitoneal hydatid cyst is necessary especially in patients who hail from rural agricultural
areas. CECT is diagnostic and provides information regarding site, size, nature and relationship to the adjacent organs
and blood vessels. Complete cystectomy is the treatment of choice. However, if dissection is difficult then a partial
cystectomy with utmost precaution to prevent spillage of contents is the best option.
Isolated Splenic Metastases from Rectal Carcinoma Five Years after Surgery: C...semualkaira
Primary splenic tumors and splenic metastases are uncommon, and
metastatic splenic tumors are even rarer [1]. According to reports,
the most common source of splenic metastases include melanoma,
tumors of the breast, lung, ovary, colon, stomach, and pancreas [2-
3]. Splenic metastases after rectal cancer surgery is very rare. This
paper reports a case of a patient with splenic metastases from rectal cancer 5 years after surgery. We discuss the route of metastasis
and treatment of this case.
Background: Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasms of the gastrointestinal (GI)
tract, occupying 0.2% of all digestive tract cancer cases. The main affected site is the stomach (50% cases). The vast majority (95%) have a mutation in the Kit gene. Surgery is the treatment of choice, with complete tumor resection with free margins, and no need for lymphadenectomy. Minimal invasive surgery may be an option, mainly for small tumors and patients with localized disease. The emergence of molecular targeted therapy has brought great advances in the treatment of unresectable metastatic tumors, and in cases of recurrence after surgical treatment.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
How to Give Better Lectures: Some Tips for Doctors
Preoperative predictive factors of liver hydatid cyst occult or frank intrabiliary rupture
1. Research article
Dougaz et al 01
Preoperative predictive factors of liver hydatid cyst occult or frank
intrabiliary rupture
Mohamed Wejih Dougaza
, Mohamed Ali Chaoucha,*
, Houcine Magherbib
, Mehdi Khalfallaha
,
Hichem Jerrayaa
, Ibtissem Bouaskera
, Ramzi Nouiraa
, Chadli Dziria
Abstract
Background: The most frequent complication of liver hydatid cyst is intrabiliary rupture (LHCIBR). This study
aimed to investigate preoperative predictive factors of occult and frank LHCIBR.
Methods: We conducted a retrospective study concerning patients operated on consecutively for liver
hydatidosis for 2 years. Patients were divided into three groups: who had no intrabiliary rupture, patients
who had an occult rupture and patients who had a frank rupture.
Results: We recorded 56 patients with 82 liver hydatid cysts. LHCIBR was occult in 16 cysts and frank in
four cysts. Bivariate analysis identified jaundice and cyst size as associated with frank LHCIBR and US cyst
type II or III, recurrent cyst, and size of the hydatid cyst as associated with occult LHCIBR. In the multivariate
analysis, we retained jaundice, cyst size > 6.5 cm and duration of symptoms > 45 days as significant predictive
factors of frank rupture and cyst size > 6.5 cm, number of recurrences ≥ 3, cyst type II or III, leukocytosis >
9.000/mm3
and eosinophilia > 5.5% as significant of occult rupture.
Conclusion: Misdiagnosis LHCIBR can lead to increased morbidity and mortality. They were avoided by
predicting cyst rupture, correct timing and type surgery, proper drainage and preoperative intensive care of
patients.
Keywords: Liver hydatid cyst; Occult intra-biliary rupture; Frank intra-biliary rupture; complication;
predictive factors
INTRODUCTION
Hydatid cyst is a worldwide zoonosis caused by Echino-
coccusgranulosus[1]
.Thesourceofinfectionisequivocal,
butitismostlikelyfrom E.granulosus eggspassedinthe
feces of wild dogs [2]
. This parasitic disease could affect
any organs [3,4]
. It affects essentially the liver. This is due
tovascularspecificitiesofthisorgan.Parasiticevolution
couldbemarkedbyseveralcomplications.Themostfre-
quent complication of liver hydatid cyst is intrabiliary
rupture [5,6]
. It presents the cornerstone of hydatid dis-
ease evolution and it may lead to acute cholangitis ow-
ing to obstruction of the biliary tree, with an increase of
morbidity and mortality rate to 50% [5,7]
. Early diagnosis
and treatment of these complicated cysts are mandato-
ry. This complication can be suggested preoperatively
regarding clinical, biological or radiological findings or
*Corresponding author: Mohamed Ali Chaouch
Mailing address: Department B of Surgery, Charles Nicolle Hospi-
tal, Tunis, Tunisia.
Email: Docmedalichaouch@gmail.com
Received: 15 September 2019 Accepted: 25 September 2019
discovered during surgery and can even be declared in
the postoperative delay by a biliary leakage. Prediction
of intrabiliary liver hydatid cyst rupture is important for
early diagnosis, proper management, and proper choice
of the surgical approach and type of surgery. This study
aimed to investigate preoperative predictive factors of
occultandfrankintrabiliaryruptureofliverhydatidcyst.
METHODS
Weconductedaretrospectivestudyconcerningpatients
operated on consecutively for liver hydatidosis for two
years. Diagnosis of liver hydatid cyst was confirmed by
ultrasound, CT-scan and hydatid cyst serology test (ELI-
SA, arc 5). We used the hospital archive for the study.
Preoperative demographic, clinical, biological and im-
aging findings characteristics were recorded. Patients
who had a past medical history of jaundice or high level
of total bilirubin value that was due to another affection
thenliverhydatidcystswereexcludedfromthestudy.All
patients underwent liver function tests (Total bilirubin
level,gamma-glutamyl-transpeptidase(GGT),Aspartate
aminotransferase and alkaline phosphatase level) and
hematologicstudies(leukocytosis,eosinophilia).Thelo-
a
Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia.
b
Department A of surgery, Rabta Hospital, Tunis, Tunisia.
Clin Surg Res Commun 2019; 3(3): 01-07
DOI: 10.31491/CSRC.2019.09.001
Creative Commons 4.0
2. ANT PUBLISHING CORPORATION
Dougaz et al 02
Figure 1. Intra-operative cholangiogramm showing a
dilated biliary tract with a filling defect in the common
bile duct due to the presence of a hydatid daughter cyst.
cation of all hydatid cysts was determined by preopera-
tive ultrasound, computed tomography and confirmed
by surgical findings. Cysts were classified preoperative-
ly according to ultrasound Gharbi classification[8]
and
intraoperatively by Couinaud’s segments of the liver [8]
.
No medical treatment (Albendazole) was used before
surgery. Only surgical management was adopted. Con-
servatives procedures were performed for all patients.
The area around the cyst was protected and covered
with packs immersed in hypertonic saline serum. This
precaution was performed to decrease the risk of par-
asite spread during cyst evacuation. The cyst was in-
cised at its protruded part. The cyst was widely opened
by excising the protruded part of the pericyst. The cyst
content was aspired and germinative membrane was
removed using forceps. The pericyst was smoothed out
and cleaned to remove even non-apparent daughter
cysts in the pericyst. The residual cavity was exanimat-
ed to look for intrabiliary rupture. A cholecystectomy
and a cholangiogram were performed when communi-
cation between the hydatid cyst and the biliary tract or
a common bile dilation were found (Figure 1). Biliary
communication was sutured when they were < 5 mm
and treated by directed fistulation when it was larger
than 5 mm. If the hydatid fluid was bile stained, with no
evidence of biliary communication, the residual cavity
wasaspiratedusingexternaldrainage.Anomentoplasty
was performed systematically to treat remained cavity.
Regarding intraoperative findings, patients were divid-
ed into three groups: patients who had no intrabiliary
rupture,patientswhohadanoccultruptureandpatients
who had a frank rupture. An occult rupture was defined
as the presence of bile in the cyst without passage of
intracystic content into the common bile duct. A frank
rupture (Figure 2) was defined as a passage of the intra-
Figure 2. Intra-operative picture showing a large liver
hydatid cyst wall in case of a frank rupture.
Figure 3. Intra-operative picture showing hydatid cyst
membrane in the common bile duct after choledecotomy.
cystic content into the biliary tree (Figure 3) with a large
bilio-cystic fistula (diameter larger than 5 mm). Collect-
ed data were analyzed using the SPSS (v.23). Continuous
variables were presented by the mean ± standard devi-
ation and qualitative variables by percentage. For com-
parison between the three groups, we used the Student
t-test and Mann-Whitney test for continuous variables
when appropriate; the chi-square test and Fisher exact
test for categorical variables. A p-value of less than 0.05
was considered significant. Receiver operating charac-
teristic (ROC) curve was used to evaluate the optimal
cut-offvalues.Thesensitivity,specificity,likelihoodratio,
and positive and negative predictive values were calcu-
lated to identify predictive factors of occult and frank
rupture in biliary tact of liver hydatid cyst.
RESULTS
Descriptive study
Our study recorded 56 patients with 82 liver hydatid
Publishedonline:29September2019
3. Dougaz et al 03
Table 1. Demographic, clinical, biological and radiological characteristics of patients.
Variables N (%)/ Median (ranges)/ Mean (± SD)
Demographic data
Median duration of symptoms in months 2 [1-16]
Age (year) 49 ± 19
Gender
Women 43 (77%)
Men 13 (23%)
Clinical presentation
Right upper quadrant abdominal pain 44 (97%)
Asymptomatic
Symptomatic
History of jaundice 4 (7%)
Nausea and vomiting 6 (11%)
Duration of symptoms (days) 180 [1-1440]
Abdominal mass 5 (9%)
Jaundice 4 (7%)
Fever 7 (13%)
Biological tests levels
Total bilirubin level (μmol/l) 14 [3.9 – 244.3]
BC 20 [2 - 175]
Alkaline phosphatase level (U/l) 94.5 [39 – 369]
GGT level 63 [11 - 506]
ALP level 101 [39 - 369]
Leukocytosis (103
/mm3
) 6850 [2300 - 23200]
Eosinophilia (103
/mm3
) 2900 [100 - 15200]
C-reactive protein 46 [3.9 - 101]
Biliary duct dilation
Yes 8 (9%)
No 71 (86.5%)
Cyst Size (cm) 7.5 [1-17]
Number of cysts
Unique cyst 32 (57%)
Multiple cysts 24 (43)
Recurrent cyst 15 (27%)
Cyst location
Right liver 64 (78%)
Left liver 13 (16%)
Both lobe 5 (6%)
Gharbi’s classification
I 18 (22%)
II 6 (7%)
III 43 (52%)
IV 14 (17%)
V 1(1%)
Cyst wall (pericyst)
Soft 35 (42.6%)
Fibrotic or calcified 4 (4.8%)
Non-mentioned 43 (52.4%)
Intra-biliary hydatic rupture 20 (36%)
Frank 4 (4,87%)
Occult 16 (19,51%)
Clin Surg Res Commun 2019; 3(3): 01-07
DOI: 10.31491/CSRC.2019.09.001
4. Dougaz et al 04
cysts. There were 13 men (23%) and 43 women (77%)
with a mean age of 49 ± 19 years. The most common
symptom was right upper quadrant abdominal pain
in 44 patients (79%). A history of jaundice was found
in four patients (7%) and seven patients (12%) were
asymptomatic. The duration of symptoms ranged from
one day to four years (median, 180 days). Abdominal
examination objectified an abdominal mass in five pa-
tients (9%). The disease was primary in 41 patients
(73%) and recurrent in 15 patients (27%). An abdom-
inal ultrasound was performed systematically and CT-
scan in 49 patients (87,5%). The majority of patients
had a single cyst, there were in 32 patients (57%) and
multiple cysts in 24 patients (43%). Associated extra-
hepatic hydatid cysts were found in 10 patients (18%).
Finally, we counted 82 liver hydatid cysts presented by
56 patients. Sixty-four cysts were located in the right
liver lobe (78%), 13 cysts in the left liver lobe (16%) and
fivecystswerebothlobe(6%).Thecystsizerangedfrom
1to17cm(median:7.5cm).Regardingultrasonography
Gharbiclassification,amongthe82cysts,18cysts(22%)
type I, 6 cysts (7%) were type II, 43 cysts (52%) were
type III, 14 cysts (17%) were type IV and one cyst was
type V. Imaging findings showed a dilation of common
bile duct in 5 patients (8,9%). All surgical procedures
were performed using an open approach and conserva-
tive treatment was adopted for all patients. Intrabiliary
rupture was detected in 20 hydatid cysts (24,4%). It was
an occult communication in 16 cysts (80%) and a frank
intra-biliary rupture in four cysts (20%)(Table 1).
Analysis study
Thebivariateanalysisallowedustoidentifythepreoper-
ativevariablesassociatedwithfrankintra-biliaryhydat-
ic rupture. There were significant statistically (p<0.05)
according to jaundice, and size of the cyst (Table 2). Con-
cerning occult intrabiliary rupture, there were signifi-
cant statistically (p<0.05) according to ultrasonography
Gharbi’s classification type II or III cyst, recurrent cyst,
and size of the hydatid cyst (Table 3).
Asconcern,thesizeofthecyst,ROCcurve(Figure4)was
used to determine the most appropriate cut-off point
which was 6.5 cm with a sensitivity of 83%, a specificity
of 60% and a negative predictive value of 92%.
In the multivariate analysis we retained jaundice, cyst
size > 6.5 cm and duration of symptoms > 45 days as sig-
nificant predictive factors of frank rupture. Concerning
occult rupture, we retained in the multivariate analysis
cyst size > 6.5 cm, a number of recurrences ≥ 3, cyst
typeIIorIII,leukocytosis>9.000/mm3
andeosinophilia
>5.5%.
DISCUSSION
Our study investigates preoperative predictive factors
of intrabiliary rupture of liver hydatid cyst in order to
perform early diagnosis and management of this com-
plication. Based on our findings, the preoperative vari-
ables associated with frank intra-biliary hydatic rupture
were jaundice and cyst’s size. Ultrasonography Gharbi’s
classification type II or III cyst, recurrent cyst and cyst’s
size were associated with occult intra biliary rupture.
Multivariate analysis retained jaundice, cyst size > 6.5
cm and duration of symptoms > 45 days as predictive
factors of frank rupture and cyst size > 6.5 cm, num-
ber of recurrences ≥ 3, cyst type II or III, leukocytosis >
9.000/mm3
andeosinophilia>5.5%aspredictivefactors
of occult rupture.
Intrabiliary hydatid cyst rupture is the most frequent
complicationofliverhydatidcysts[6,10,11]
.Thereisnocon-
sensus concerning the terminology of hydatid cyst with
intrabiliary rupture [5,12]
. Its incidence depends largely
Figure 4. The ROC curve for the cyst diameter.
on the definition used to retain the occurrence of this
rupture [5]
. In the literature, it was between 21 and 37%
[12,13]
. Prediction of intrabiliary liver hydatid cyst rupture
using clinical, biological and imaging factors is impor-
tant for early diagnosis and proper management to en-
hance post-operative outcomes [14]
. It is commonly ad-
mitted that intrabiliary cyst rupture is related to higher
morbidity and mortality rates [5,12]
. Intracystic pressure
increases along with the diameter of a hydatid cyst and
lead to a spontaneous intrabiliary rupture [6]
. This pres-
sure causes intermittent passage of cyst fluid and minor
fragments into the biliary system. However, an apparent
biliaryobstructiondoesnotoccur[9]
.Aclearhydatidfluid
without bile in the cyst cavity does not mean an intact
ANT PUBLISHING CORPORATION
Publishedonline:29September2019
5. Dougaz et al 05
cyst wall. Liver hydatid cyst intra biliary rupture is the
major turning-point in the liver hydatid cyst evolution.
It leads to cyst infection, cholangitis, sepsis, jaundice,
pancreatitis, acute cholecystitis and liver abscesses
[11,15,16]
. Even late biliary cirrhosis could be reported [17]
.
In addition, when intrabiliary rupture was suspected,
percutaneous drainage and the use of scolicidal agents
should be avoided because of septic complications and
the risk of sclerosing cholangitis [5]
. Suitable treatment
may avoid postoperative cystic cavity-related compli-
cations [5]
.
The cysto-biliary fistula may occur essentially in two
forms: an occult rupture in 10% to 37% of cases or a
frank rupture in 3% to 17% of cases [5,7,18]
. In our study,
the overall incidence of the cysto-biliary fistula was
24%. There was frank rupture in 4.87% and occult rup-
ture in 19.51% of cysts.
The frank intrabiliary rupture is easily suggested pre-
operatively. Careful past medical history, patient story,
physical examination, and complementary exams pre-
dict this complication [19,20]
. There was essentially ob-
structive jaundice, hyperbilirubinemia, gama-glutamyl
transferase or levels of alkaline transferase in the blood
samples [19,21]
. Even cholangitis can be observed in some
cases [22]
. CT-scan and ultrasound are useful diagnostic
tools [23,24]
. The presence of associated liver hydatid cyst,
dilated biliary tract with cholangitis are strongly sug-
gestive of frank intrabiliary rupture [25]
. In the case of
frankrupture,abdominalultrasoundhadasensitivityof
66,7% and a specificity of 100% [7]
. Concerning abdom-
inal CT-scan, it detects 75% of major cysts rupture [14]
.
Atlietal[7]
reportedsuggestiveultrasoundfindings,type
IV cysts and a cyst diameter larger than 10.5 cm as in-
dependent imaging predictive factors of frank rupture.
Al-Bahrani et al [26]
had investigated predictive factors
of frank intrabiliary rupture in a study concerning 741
patients operated between 1965 and 2000. Multivari-
ate analysis identified cyst size (≥10 cm), cyst infection,
multivesicularcontent,solitarycystsandlocationinthe
left lobe of liver as well as long duration of symptoms as
independentpredictorsoffrank intrabiliary rupture[26]
.
Table 2. Comparison between frank rupture or occult rupture versus no intrabiliary rupture of the liver hydatid cysts
(bivariate analysis).
Variables Intrabiliary rupture (n=20) No rupture (n=62) P
Frank rupture (n=4)
Occult rupture
(n=16)
Frank
rupture
Occult
rupture
Age (year) 48 ± 17 45 ± 17 49 ± 19 0.925 0.488
Jaundice 2 (50%) 2 (1.25%) 3 (5%) 0.026 0.618
Abdominal mass 2 (50%) 1 (0.625%) 6 (10%) 0.069 0.681
Leukocytosis 10566 ± 3056 9156 ± 4518 7454 ± 3212 0.052 0.115
Size of cyst (cm) 11 ± 3 10 ± 3 5 ± 3 0.010 0.004
Type II or III 4 (100%) 15 (94%) 28 (45%) 0.050 < 0.001
Occult intrabiliary rupture of hydatid cyst is more fre-
quent, asymptomatic and intraoperatively diagnosed
[7,25]
. It must keep in mind that these occult fistulas may
give rise to a frank perforation at any time. Then early
diagnose and management is important. These ruptures
were defined as the presence of bile in the cyst without
passageofintracysticcontentintothecommonbileduct.
Thus,anapparentbiliaryobstructiondoesnotoccur.Dif-
ferent variables have been reported as risk factors for
cysto-biliary fistula in the literature.
Atlietal[7]
,inaseriesof116patients,foundthatahistory
of nausea and vomiting, a serum ALP level greater than
144 UI/l, a total bilirubin level greater than 0,8 mg/dl,
and cyst size greater than 14.5 cm were associated to
occult intrabiliary cyst rupture.
Imaging features are not very helpful to detect occult in-
trabiliary cyst rupture [13]
. Often this complication is dis-
covered intra-operatively proved by bile in the hydatid
cyst fluid[27]
. Diagnosis is performed by the detection of
a bilio-cystic fistula in the cyst wall during surgery or
during intraoperative cholangiogram and even by ERCP
performed before surgery [5]
. Magnetic resonance chol-
angiographymaybecomeaneffectivediagnostictoolbut
now it is yet to be defined in the assessment of hydatid
cyst intrabiliary rupture[28,29]
. Among the different stud-
ies illustrated, cyst size seems to be the most important
factor. In our study, hydatid cyst type II or III and cyst
sizeabove6.5cmwereapredictivefactorofcysto-biliary
fistula. Atli [7]
and Unalp[13]
reported respectively a cyst
diameter above 10.5 and 10 cm as predictive factors of
occultintrabiliarycystrupturewithnorelationbetween
biliary leakage and nature of the cysts, whether primary
or recurrent, single or multiple and their location (right
lobe, left lobe or both).
This complication could affect the surgeon’s choice re-
garding the surgical approach (Laparoscopy or lapa-
rotomy)[30]
and the surgical procedure (conservative or
radical treatment) [31]
.
Since cyst-biliary communication is a life-threatening
condition, early diagnosis and treatment are mandatory.
Surgeons should suspect a cysto-biliary communication
Clin Surg Res Commun 2019; 3(3): 01-07
DOI: 10.31491/CSRC.2019.09.001
6. Dougaz et al 06
Table 3. Results of multivariate analysis of predictive factors.
Variables OR %95 CI P
Frank cysto-biliary intrabiliary rupture
Jaundice 19.7 2 – 191.8 0.026
Size > 6.5 cm 8.6 3 - 19 0.033
Duration of symptoms > 45 days 29.4 2.6 – 338.3 0.007
Occult cysto-biliary intrabiliary rupture
Size > 6.5 cm 6.4 1.6 – 24.8 0.033
Number of recurrences ≥ 3 14 1.3 – 146.3 0.026
Type II or III 18.2 2.3 – 146.5 < 0.001
Leukocytosis > 9,000/mm3
4.5 1.3 – 15.1 0.018
Eosinophilia > 5.5% 6.5 1.3 – 33 0.029
of a hydatid cyst if patient presents risk factors. In this
situation, a broad-spectrum antibiotic should be chosen
forprophylaxisandpatientsshouldbetreatedsurgically
as early as possible. In addition, suggesting intrabiliary
ruptureoftheliverhydatidcystcanbeusefulinpatient’s
selection to percutaneous treatment or laparoscopy
[30,32,33]
. Intraoperative cholangiography should be done
systematically[6]
.
Thelimitationofthisstudyisbeingaretrospectivestudy.
The character of peri cyst thick was evaluated by the
surgeons with no standard definition attributed.
CONCLUSION
Misdiagnosis of intrabiliary rupture of hepatic hydatid
cyst can lead to increasing postoperative cavity-related
complications. Cysto-biliary communication should be
suspected preoperatively and searched carefully intra-
operatively in the presence of preoperative predictive
factors. Itcouldaffectthesurgeon’schoiceregardingthe
surgical approach (Laparoscopy or laparotomy) and the
surgical procedure (conservative or radical treatment).
In conclusion, decreasing morbidity and mortality were
warranted by predicting intrabiliary cyst rupture, cor-
rect timing, and type of surgery, proper drainage and
preoperative intensive care of patients.
CONFLICT OF INTEREST
Authors had no conflicts of interest to disclose.
REFERENCES
1. Dziri, C., Haouet, K., Fingerhut, A., & Zaouche, A. (2009).
Management of cystic echinococcosis complications and
dissemination: where is the evidence?. World journal of
surgery, 33(6), 1266-1273.
2. Jenkins,D.J.,Williams,T.,Raidal,S.,Gauci,C.,&Lightowlers,
M. W. (2019). The first report of hydatid disease
(Echinococcus granulosus) in an Australian water buffalo
(Bubalus bubalis). International Journal for Parasitology:
Parasites and Wildlife, 8, 256-259.
3. Dougaz, M. W., Chaouch, M. A., Derbel, B., Achouri, L.,
Bouasker, I., & Nouira, R. (2019). An unusual zoonotic
parasite’s disease causing a breast mass: Breast hydatid
cyst. International Journal of Infectious Diseases.
4. Dziri, C. (2001). Hydatid disease-continuing serious
public health problem: introduction. World journal of
surgery, 25(1), 1-3.
5. Kayaalp, C., Bostanci, B., Yol, S., & Akoglu, M. (2003).
Distribution of hydatid cysts into the liver with reference
to cystobiliary communications and cavity-related
complications. The American journal of surgery, 185(2),
175-179.
6. Nacef, K., Chaouch, M. A., Ben Khalifa, M., Chaouch, A.,
Ghannouchi, M., Maatouk, M., & Boudokhane, M. (2017).
Liverhydatidcystcomplicatedbybiliaryandcolonicfistula
diagnosedafterintra-operativecholangiography. Surgical
Infections Case Reports, 2(1), 92-94.
7. Atli, M., Kama, N. A., Yuksek, Y. N., Doganay, M., Gozalan,
U., Kologlu, M., & Daglar, G. (2001). Intrabiliary rupture
of a hepatic hydatid cyst: associated clinical factors and
proper management. Archives of Surgery, 136(11), 1249-
1255.
8. Gharbi, H. A., Hassine, W., Brauner, M. W., & Dupuch, K.
(1981). Ultrasound examination of the hydatic liver.
Radiology, 139(2), 459-463.
9. Bismuth, H. (1982). Surgical anatomy and anatomical
surgery of the liver. World journal of surgery, 6(1), 3-9.
10. Chaouch, M. A., Dougaz, M. W., Khalfallah, M., Jerraya, H.,
Nouira, R., Bouasker, I., & Dziri, C. (2019). A case report
of complicated appendicular hydatid cyst mimicking an
appendicealmucocele. Clinicaljournalofgastroenterology,
1-4.
11. Pinto, P., Gaete, S., & Vega, P. (2019). Utility of ERCP in the
Diagnosis and Management of Biliary Complications of
Hepatic Hydatid Disease. In Echinococcosis. IntechOpen.
12. El Malki, H. O., El Mejdoubi, Y., Souadka, A., Mohsine, R.,
Ifrine, L., Abouqal, R., & Belkouchi, A. (2010). Predictive
model of biliocystic communication in liver hydatid cysts
using classification and regression tree analysis. BMC
surgery, 10(1), 16.
13. Unalp, H. R., Baydar, B., Kamer, E., Yilmaz, Y., Issever, H.,
ANT PUBLISHING CORPORATION
Publishedonline:29September2019
7. Dougaz et al 07
& Tarcan, E. (2009). Asymptomatic occult cysto-biliary
communicationwithoutbileintocavityoftheliverhydatid
cyst: a pitfall in conservative surgery. International
Journal of Surgery, 7(4), 387-391.
14. Reddy, A. D., & Thota, A. (2018). Cysto-biliary
communication (CBC) in hepatic hydatidosis: predictors,
management and outcome. International Surgery
Journal, 6(1), 61-65.
15. i Gavara, C. G., López-Andújar, R., Ibáñez, T. B., Ángel, J. M.
R., Herraiz, Á. M., Castellanos, F. O., et al. (2015). Review
of the treatment of liver hydatid cysts. World Journal of
Gastroenterology: WJG, 21(1), 124.
16. Sáez-Royuela, F., Yuguero, L., López-Morante, A., Pérez-
Álvarez, J. C., Martín-Lorente, J. L., & Ojeda, C. (1999).
Acute pancreatitis caused by hydatid membranes in the
biliary tract: treatment with endoscopic sphincterotomy
. Gastrointestinal endoscopy, 49(6), 793-796.
17. Kattan, Y. B. (1975). Intrabiliary rupture of hydatid cyst
of the liver. British Journal of Surgery, 62(11), 885-890.
18. Becker, K., Frieling, T., Saleh, A., & Häussinger, D. (1997).
Resolution of hydatid liver cyst by spontaneous rupture
into the biliary tract. Journal of hepatology, 26(6), 1408-
1412.
19. Kornaros SE, Aboul-Nour TA. (1996).Frank intrabiliary
rupture of hydatid hepatic cyst: diagnosis and treatment.
J Am Coll Surg, 183(5),466–70.
20. Ulualp, K. M., Aydemir, I., Senturk, H., Eyuboğlu, E., Cebeci,
H., Unal, G., & Unal, H. (1995). Management of intrabiliary
rupture of hydatid cyst of the liver. World journal of
surgery, 19(5), 720-724.
21. Akkapulu, N., Aytac, H. O., Arer, I. M., Kus, M., & Yabanoglu,
H. (2018). Incidence and risk factors of biliary fistulation
from a hepatic hydatid cyst in clinically asymptomatic
patients. Tropical doctor, 48(1), 20-24.
22. Delso, J. G., Larramona, S. F., Olmo, J. F., & Amezaga, R. U.
(2019).Acutecholangitissecondarytohydatidmembranes
in the biliary tract. Gastrointestinal endoscopy, 89(1),
199-200.
23. Valle-Sanz Y del, Lorente-Ramos RM. (2004)Sonographic
and computed tomographic demonstration of hydatid
cysts communicating with the biliary tree. Journal of
Clinical Ultrasound, 32(3),144–148.
24. Chaouch, M. A., Dougaz, M. W., Cherni, S., & Nouira, R.
(2019). Daughter cyst sign in liver hydatid cyst. Journal
of Parasitic Diseases, 1-2.
25. Prousalidis, J., Kosmidis, C., Kapoutzis, K., Fachantidis, E.,
Harlaftis, N., & Aletras, H. (2009). Intrabiliary rupture of
hydatidcystsoftheliver.TheAmericanJournalofSurgery,
197(2), 193-198.
26. Al-Bahrani,A.Z.,Al-Maiyah,M.,Ammori,B.J.,&Al-Bahrani,
Z. R. (2007). Factors predictive of frank intrabiliary
rupture in patients with hepatic hydatid cysts. Hepato-
gastroenterology, 54(73), 214-217.
27. Atahan, K., Küpeli, H., Deniz, M., Gür, S., Çökmez, A., &
Tarcan,E.(2011).Canoccultcystobiliaryfistulasinhepatic
hydatiddiseasebepredictedbeforesurgery?. International
journal of medical sciences, 8(4), 315.
28. Marti-Bonmati,L.,&Serrano,F.M.(1990).Complicationsof
hepatic hydatid cysts: ultrasound, computed tomography,
and magnetic resonance diagnosis. Gastrointestinal
radiology, 15(1), 119-125.
29. Laghi, A., Teggi, A., Pavone, P., Franchi, C., De Rosa, F., &
Passariello, R. (1998). Intrabiliary rupture of hepatic
hydatid cysts: diagnosis by use of magnetic resonance
cholangiography. Clinical infectious diseases, 1465-1467.
30. Jerraya, H., Khalfallah, M., Osman, S. B., Nouira, R., & Dziri,
C. (2015). Predictive factors of recurrence after surgical
treatmentforliverhydatidcyst. Surgicalendoscopy, 29(1),
86-93.
31. Dziri, C., Dougaz, W., Samaali, I., Khalfallah, M., Jerraya, M.,
Mzabi, R., et al. (2019). Radical surgery decreases overall
morbidity and recurrence compared with conservative
surgery for liver cystic echinococcosis: systematic
review with meta-analysis. Annals of Laparoscopic and
Endoscopic Surgery, 4.
32. Yorganci, K., & Sayek, I. (2002). Surgical treatment of
hydatid cysts of the liver in the era of percutaneous
treatment. The American journal of surgery, 184(1), 63-
69.
33. El Malki, H. O., Amahzoune, M., Benkhraba, K., El Kaoui, H.,
Elmejdoubi, Y., Mohsine, R., et als. (2006). Le traitement
conservateur du kyste hydatique de la rate. Médecine du
Maghreb, 139, 33-38.
Clin Surg Res Commun 2019; 3(3): 01-07
DOI: 10.31491/CSRC.2019.09.001