Stage-specific approach and percutaneous treatment in the management of cystic echinococcosis
Abstract number: S288
The percutaneous treatment of liver hydatid cysts were considered to be contraindicated due to two main potential risks: anaphylactic shock and abdominal dissemination of the disease. Since the first case percutaneously treated was published, several series of successful percutaneous treatment of the liver and the other abdominal organs, peritoneum, thorax, soft tissue and orbital cavity hydatid cysts have appeared in the literature.
The main indication for percutaneous treatment of hydatid cyst includes "viable cysts". Different types according to Gharbi or WHO classifications are treated by different percutaneous techniques. According to WHO classification, CE 1 and 3A are considered to be most appropriate for PAIR; CE 2 for Catheterisation technique or Modified catheterisation technique (MoCaT or PEVAC); CE 3B for MoCaT. No treatment is necessary in patients with CE 4 and 5 which are managed by "Wait and Watch approach". Although surgery is a traditional method of treatment, the indication for surgery is now limited by the hydatid cysts ruptured into biliary system, pleura or peritoneum.
Three different techniques are used in percutaneous treatment of liver hydatid cysts. The first one is; the PAIR technique described by Ben-Amour et al. in 1986. PAIR is the abbreviation of Puncture, Aspiration of cyst content, Injection of hypertonic saline solution, and Reaspiration of all fluid. The second one is the Catheterisation technique with hypertonic saline and alcohol described by Akhan et al. in an experimental study in sheep in 1993. The third one is called as modified catheterisation techniques such as MoCaT or PEVAC. After standard steps of catheterisation techniques a 14F catheter is inserted into the cavity to evacuate all the content. Aggressive irrigation with isotonic NaCl is employed via the catheter to have the cavity emptied.
Considering the number of percutaneously treated patients, it is reasonable to conclude that the mortality rate is about 0.047%. Dissemination after percutaneous treatment of the liver hydatid disease was never reported in any of the published series. Other major complications need to be addressed are superinfection of the cavity, cystobiliary communication and severe anaphylactic reaction with a reported overall rate of about 10%. Minor complications such as urticaria, severe itching and hypotension can easily be treated with antihistaminic. In some patients fever, not exceeding 38.5°C, may also be observed and generally does not necessitate any medication.
Recurrence rate varies among 04%. Recurrent cysts are also managed by percutaneous approach. Considering the overall data in the literature regarding hospital stay is about 2.54.2 days.
Percutaneous treatment of hydatid liver disease is an effective and safe procedure with its unique advantages (e.g., shorter hospital stay, low complication rate). Today, the percutaneous approach has an important role in treatment of hydatid cysts not only in the liver but also in the other organs and tissue. Therefore it must be first treatment option whenever it is indicated.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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