Publications of Faculty of Medicine:Management Of Hepatic Hydatid Disease In Yemen "An Analysis Of 36 Cases: Abstract

Management Of Hepatic Hydatid Disease In Yemen "An Analysis Of 36 Cases
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Hydatid disease of liver is highly prevalent in oriental countries in which their population, live mostly in rural areas, and sheep breeding region, so the incidence is high in Yemen, where hydatid cysts are endemic disease and hydatid disease of liver is still a major cause of morbidity. This study was done in Al Saudi hospital in Yemen 10 evaluate the results of different modalities, of treatment, of hydatid disease of liver (HDL).36 patients with "H.D.L." were treated and followed up between 1999 and 2003. 19 were males and 17 were females. The mean age was 35 years (range 6-60 years). The most common complaints were a right upper quadrant abdominal pain, and abdominal mass, which were present in (77.8%) and (33.3%), respectively. In 29 cases (80.56%) the cysts were in right lobe of liver, in 2 cases (5.56%) cysts were in the left lobe, and in 5 cases (13.88%) cysts were in both lobes. 8 patients (22.22%) had multiple hepatic cysts, and 3 cases (8.33%) had concomitant pulmonary hydatidosis. 2 patients (5.56%) had previous surgery for (H.D.L). In 31 cases (86.11%) cysts were larger than 10 cm in diameter. 6 patients (16.67%) were found to have complicated hepatic hydatid disease, tholangias due to imrabiliary rupture in I case (2.78%), large biliocystic fistula with obstructive jaundice in 1 case (2.78%), peritonitis due to intraperiumeal rupture in 1 case (2.78%), frank suppuration "liver abscess" in 1 case (2.78%) and calcification of cyst wall in 2 cases (5.56%), one of them protrude into the peritoneal cavity, Diagnosis was based primarily on ultrasonography. Patients were treated with oral albendazole 10 mg/kg / day for 3 weeks before operation, or oral praziquantel for 2 days preoperatively for 3 patients underwent emergency surgery "obstructive jaundice, liver abscess, and intraperiumeal rupture". patients received albendazole for 3 months postoperatively. Long - term albendazole therapy were applied jiff a high risk patients "multiple cysts (n = 8) (22.27%) and recurrent cases (n = 2) (5.56%)". A radical procedure was perlbrmed 3 times (8.33%), It consisted in total pericysteetomy in 2 cases, (5.56%) and hepatic resection in I case, (2.78%), A conservative procedure was performed in 33 cases (91.67%), it consisted in partial tystectomy "endocystectomy" and omentoplasty (n = 15) (41.66%), capitonnage (n = 2) (556%), interojlexion and omentoplasty (n = 3) 8.33%), external drainage (n = 3) (8.33%), and open drainage (n = 3) (8.33%). A combined technique was appliedfir multiple cysts. Omentoplasty and Capitonnage (n = 3) (8.33%), omentoplasty and external drainage (n = 3) (8.33%), external drainage and open drainage (n = I) (2.78%). 2 patients (5.56%) developed binary fistula and I patient (2.78% developed infection of residual cavity following drainage procedure. 1 patient (2.78%) developed cholangitis after interaflexion. After a median follow up period of 1.8 years (range 1-4), there were no recurrent cysts. Conclusion: Combined medical treatment can be given but not an alternative to surgery. Conservative surgical approaches "partial cysteconsy" is the treatment (y. choice. Omenumlastv is the most efiective modalities jar management of HDL. Radical surgery is ofien serious, it can be pet:Pa:ed.& easily accessible cyst in the left lobe or anterior segments of liver, with a thick calcified pericyst or protruded cyst. Sterile Methylene blue injection into binary system is useful technique to identlfr the site of bilocystic fistula. The unroofing procedure with suturing of the biliocystic fistula and omentoplasty is an effective method for management of biliogstic fistula. Surgical treatment of hydatid disease of liver without drainage, decreases post operative complications rate and average hospitalization period