Diagnostic evaluation and surgical managementof recurrent hydatid cysts in an endemic region

Abstract

Background. Echinococcosis is a zoonotic disease that occurs mainly in endemic areas. Recurrent hydatid cyst (RHC) and its diagnosis present insidious problems for surgeons. The aim of this study was to evaluate the diagnosis and surgical management of RHC in Turkey, where the disease is endemic.

Methods. We conducted a comprehensive study of 146 patients with abdominal hydatid cysts that were managed surgically between 1997 and 2007. Among those patients, RHC arose in 14 (9.5%) of cases.

Results. The female to male patient-ratio was 6 to 8 and median age was 47.4 years. Patients’ symptoms included abdominal pain, nausea, fever, and jaundice. Cysts reoccurred in patients sporadically between 4 months and 22 years. Abdominal US, CT, and MRI were utilized for the diagnosis in 14 (100%), 11 (78.5%), and 2 (14.2%) patients respectively, demonstrating the RHC of the liver and concomitant cysts (splenic region, mesentery of the colon and perivesical) in all cases, respectively. The recurrent cysts (with a mean diameter of 12 cm) were removed using partial pericystectomy, introflexion, and total cystectomy surgical techniques. Postoperative morbidity occurred in 14% of patients.

Conclusions. Especially in endemic countries like Turkey, RHC should be included in the differential diagnosis of cystic masses in abdominal organs that were previously treated for hydatid cysts. Surgery still remains the treatment of choice for RHC with early management and proper perioperative evaluation contributing to a high cure rate.