Ozgur Turk1*, Hasan Polat1 and Bartu Badak1
1Sivrihisar State Hospital, General Surgery Department, Eskisehir, Turkey
2Banaz State Hospital, General Surgery Department, Eskişehir, Turkey
Received: 27 October, 2015; Accepted: 17 November, 2015; Published: 19 November, 2015
Ozgur Turk, Sivrihisar State Hospital, General Surgery Department 26040 Eskisehir, Turkey, Tel: +905054403377; Fax: +902227112002; E-mail:
Turk O, Polat H, Badak B (2015) Primary Multiple Giant Hydatid Cyst of the Liver: A Case Report. J Surg Surgical Res 1(3): 076-00.10.17352/2455-2968.000018
© 2015 Turk O et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Hydatid cyst; Liver; Echinococcus
Hydatid cyst is a parasitic infection of liver. One of frequent reason of liver mass is hydatid cyst in tropical and rural countries. In some cases rapidly grow up of cyst mimic liver masses. A sixty years old female admitted our hospital with abdominal pain. Abdominal ultrasound showed 74x75 mm in segment two, 115x91 mm in segment six and 115x62 mm in segment four type four hydatid cysts. Patient was admitted for surgery; pericystectomy and omentoplasty performed. In multiple cysts surgical management is sometimes difficult. It is better to drain all the cysts at the same time. Surgical interventions can prevent complications and spread of Echinococcosis also gives chance of curative treatment.
Hydatid cyst is a parasitic infection of liver. One of the most frequent reason of the liver mass is hydatid cyst in tropical and rural countries. Infection of Echinococcus granulosus larvae lied behind of this disease. The most effected organ is liver (75%) and lung (15%) . Other rare seen anatomical locations are brain, breast, heart, spleen, bone, spleen, abdominal wall. Clinical symptoms are varied according to the size, anatomic location and stage of hydatid cyst. The course of the disease can be silent in most patients until a complication occurs or raise the size of cyst a huge amount . In some cases rapidly grow up of cyst mimic liver masses. Composition of clinical history, family history, physical examination, serological and immunological studies direct definitive diagnosis. The most used diagnostic method for differential diagnosis is abdominal ultrasound (USG). Abdominal tomography (CT) or magnetic resonance imaging (MRI) are used for advanced diagnosis. There are lots of techniques can be used for treatment such as medical treatment, percutaneous aspiration and surgical removal of cyst . Here, we want to report a primary multiple giant hydatid cyst of liver widespread in right and left lobe. This case is interesting because of the plenty of the cysts and dimensions.
A sixty years old female admitted our hospital with abdominal pain. She had not any surgical history. Family history of the patient was unremarkable. On physical examination, a rigid and tense abdominal mass was palpable filling upper abdomen. In laboratory studies, there was no hematological abnormality; biochemistry results were unremarkable. Anti-Echinococcus antibodies were not evaluated. Brucella agglutination test was positive. Abdominal ultrasound showed 74x75 mm in segment two, 115x91 mm in segment six and 115x62 mm in segment four type four hydatid cysts (Figure 1). Abdominal tomography performed for differential diagnosis and result: increased liver size and 96x56 mm measured cyst in segment four; 90x97 mm measured cyst in segment six and seven; 73x64 mm measured cyst in segment two and three (Figure 2). Patient was evaluated for PAIR treatment but because of the multiple location and dimensions of the cysts patient was admitted for surgery. During surgical exploration; there was three giant hydatid cyst filling both right and left lobe of the liver. Falciform ligament ligated and liver normalized. Hypertonic 3% NaCl solution injected into the cyst that at the left lobe of the liver. After fifteen minutes cyst aspirated and pericystectomy was performed by with a Harmonic scalpel (Ethicon Endo-Surgery, Inc., Cincinnati, Ohio) until the border of healthy liver parenchyma. There was no bleeding from the liver. Same surgical procedure performed for another two cysts. There was a biliary fistula in the residual cyst cavity in segment four and two. Biliary fistulas primarily sutured. After pericystectomy omentum was packed into residual cavity and fixed. Drains placed in sub hepatic, sub diaphragmatic area. Postoperative period was uneventful. Drains removed four days after surgery. Patient was discharged nine days after surgery with the Albendazole treatment. During at 6 months follow up of patient there was no problem and no recurrence of hydatid cyst.
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