Cases reported "Echinococcosis, Hepatic"

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11/16. Sclerosing cholangitis after surgical treatment of hepatic echinococcal cysts. Report of three cases.

    Three patients with sclerosing cholangitis after surgical treatment of echinococcosis of the liver are described. Before surgery, they had clinical symptoms that suggested a communication between the cyst and the biliary tract and, in two of them, the communication was later demonstrated by cholangiography. In each case, the cyst was injected with formalin solution. Soon after operation chronic cholestasis developed, with operative, cholangiographic, and histologic data suggesting sclerosing cholangitis. The role of formalin in the pathogenesis of this condition is discussed herein.
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12/16. Caustic sclerosing cholangitis. Report of four cases and a cumulative review of the literature.

    We report on four patients of our own and another thirty-six from the literature, who developed almost identical and unusual clinical syndromes after surgical treatment of hydatid disease of the liver, with the aim of showing the extremely serious nature of the problem that can ensue. An association of four factors seems to be necessary to promote caustic sclerosing cholangitis: a) injection of a scolicidal agent (formalin, hypertonic saline, ethanol, silver nitrate or iodine solution) into the cyst cavity; b) a communication between the cyst and the biliary tree; c) a condition that prolongs the exposure of the biliary tree to the scolicidal; and d) a particular sensitivity to the scolicidal agent. While this last condition cannot be anticipated, we may justifiably conclude that surgeons should not inject a scolicidal solution into the hydatid cyst, but prevent intra-abdominal diffusion of the parasite by using hydrogen peroxide, gauze pads moistened by a scolicidal solution or by preoperative chemotherapy with albendazole. Caustic sclerosing cholangitis has an earlier onset of symptoms and a more rapidly progressive nature than primary sclerosing cholangitis. In foresight, serum alkaline phosphatase should be monitored and, when raised, a retrograde endoscopic cholangiogram and/or a liver biopsy should be performed. Digestive shunt surgery should be avoided and the possibility of liver transplantation has to be periodically evaluated.
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13/16. Bronchobiliary fistula due to echinococcosis of the liver.

    In greece, which has the second highest incidence of echinococcosis in the world, there has been an overall decrease in the frequency of this disease and its complications during the past 15 years. Between 1920 and 1960, approximately 46 patients per year were operated on for echinococcosis at the Hellenic red cross Hospital, and 1.8% of 1037 hepatic hydatid cysts had ruptured into the bronchi. From 1960 to 1975, the number of patients requiring operation decreased to approximately 25 per year, and incidence of rupture into the bronchi declined to 1% of 288 liver cysts. The reduction has resulted from improvements in preventive medicine and surgical care and a decrease in the frequency of infected cysts. Bronchobiliary fistula is a serious complication of hydatid cyst of the liver and it must be treated surgically. A right thoracotomy or thoracoabdominal approach offers the possibility of dealing simultaneously with the hepatic cyst and the pulmonary lesions. The choice of operation depends on the findings and ranges from simple drainage of the hepatic cavity with division of the bronchobiliary communication, to resection of the lung (usually lobectomy) when a chronically infected pulmonary cavity is present. If a hydatid cyst of the liver ruptures simultaneously into the lung and the extra-hepatic biliary tree with resultant obstruction of the common bile duct, unblocking of the common duct by evacuation of cysts and debris through a laparotomy takes priority over any other surgical action. Of 3 patients with bronchobiliary fistulas treated during the past 15 years, 2 were cured by simple drainage through a transabdominal approach.
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14/16. Thalamic hydatid cyst: contrast-enhanced MR imaging findings.

    The case is presented of a 4-yr-old boy with a thalamic hydatid cyst. On a MR imaging study, the pericyst, as well as the germinal layer of the lesion, apparently showed enhancement after administration of the contrast medium. A few previous MR imaging studies on cerebral hydatid cysts described such enhancement; however, its mechanism was unclear. In this communication we propose a mechanism on enhancement of the cystic walls.
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15/16. Hydatid acute pancreatitis: a rare complication of hydatid liver disease. Report of two cases.

    Acute pancreatitis (AP) is known to be a rare complication of hydatid disease. We present two cases of AP due to intrabiliary ruptured hydatid cysts of the liver. High serum and urine amylase levels and ultrasonographic findings, compatible with AP, were detected. On ultrasonography and computed tomography dilated bile ducts and cystic masses in the liver were seen. A communication between the bile ducts and a cyst in one case, and a total common bile duct obstruction with hydatid material in the other case, were seen on endoscopic retrograde cholangiopancreatograms. The patients were treated surgically with mainly omentoplasty. Recovery was uneventful. A diagnosis of AP should be kept in mind in patients with hydatid liver disease presenting with upper abdominal pain.
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16/16. Intrabiliary rupture of hepatic hydatid cyst--imaging features.

    Intrabiliary rupture leading to biliary obstruction is a rare but serious presentation of hepatic echinococcosis. Four such cases are presented. Imaging studies including sonography, computed tomography and/or cholangiography, done in all patients led to a definite preoperative diagnosis which was later confirmed at surgery. Biliary tree dilatation was detected in three out of four patients, hydatid contents were seen in three patients and definite cysto-biliary communication was documented in two.
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