HYDATID CYST OF THE LIVER

• Hydatid cyst occurs as a result of infection by the larval cyst stage of the tapeworm, Echinococcus granulosus.
• Dog is the common definite host.
• Intermediate host is sheep, man.

    

Life cycle of Hydatid Cyst-

    

 

ETIOLOGY-

• MC organism – Echinococcus granulosus (unilocular cyst)
• E. Multilocularis- multilocular cyst and can cause malignant hydatidosis.

 

MORPHOLOGICAL FEATURES-

• Cyst wall has 3 layers-

a) Pericyst (adventitia/ pseudocyst)

• Outer host inflammatory reaction.
• Fibrous layer

b) Ectocyst (laminated membrane)

• Intermediate layer. White and elastic.

c) Endocyst-

• Innermost germinal layer
• Secrets hydatid fluid inside.
• Hydatid sand- grain like material composed of scolices present in fluid.

    

CLINICAL FEATURES-

• Route of infection- faeco- oral route
• Equal in male and female
• Organs involved- liver> lungs> spleen > kidney > brain > bone
• Pain in upper abdomen
• Hepatomegaly
• Typical hydatid thrill- by 3 finger method
• Asymptomatic
• Liver cysts occur more frequently in the right lobe.
• Least common site of calcified hydatid cyst.

    

INVESTIGATIONS-

• USG- detect localise and used for aspiration of cyst
• X- ray abdomen- speckled calcification
• CT scan
• ERCP- drainage of hydatid contents into duodenum
• Casoni’s intradermal cyst- sensitivity and specificity test is low. Not in use now.
• ELISA and immunoelectrophoresis- shows diagnosis (Serological tests are the most sensitive and specific tests; includes Immunoblast test, arcs test, ELISA and indirect hemagglutination tests)

    

TREATMENT-

1. Albendazole- 400 mg BD for 21 days
2. Surgery-

• Laprotomy and isolation of the cyst from peritoneal cavity in hypochlorite solution
• Aspirate and Inject scolicidal agents .
• Incise the cyst

1. Percutaneous drainage-

• Also called as PAIR (Puncture, aspiration, injection and reaspiration (MC technique)
• Cyst evacuation + omentopexy/ omentoplasty
• Pericystectomy- most effective treatment for hydatid cyst
• Hepatic resection- kost radial treatment for hydatid cyst
• SCOLICIDAL AGENTS-

a) Hypertonic saline (20%)

b) 0.5% cetrimide with 0.05% chlorhexidine

c) Absolute alcohol

d) 10% iodine

INDICATIONS FOR SURGERY-

• Unilocular uncomplicated cyst
• Poor surgical candidate
• Previous multiple abdominal surgeries
• Relapse following surgery

CONTRAINDICATIONS FOR SURGERY-

• Multiple septal divisions
• Communicating cysts
• Dead or inactive cysts
• Laparoscopic approach

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