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Hydatid disease of the liver in children
A al-Bassam1, H Hassab, Y al-Olayet
1Department of Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
Insights
Surgery for pediatric liver hydatid disease, a parasitic infection, showed no deaths but complications. Primary closure of the cyst cavity without drainage appears to be the most effective surgical approach.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Surgery
- Parasitology
Background:
- Hydatid disease of the liver is a parasitic infection caused by Echinococcus tapeworms.
- Pediatric liver hydatid disease requires surgical intervention, with various techniques described.
- Understanding optimal surgical strategies is crucial for managing this condition in children.
Purpose of the Study:
- To evaluate surgical outcomes for pediatric liver hydatid disease.
- To identify the most effective surgical treatment for hydatid cysts in children.
- To analyze complications and long-term results of surgical management.
Main Methods:
- Retrospective review of 21 children undergoing surgery for liver hydatid disease between 1986 and 1997.
- Diagnosis confirmed via clinical presentation, skin testing, serology, and imaging.
- Surgical interventions included capitonnage with partial excision, total excision, and external drainage; all patients received pre-operative mebendazole.
Main Results:
- The commonest symptoms were abdominal distention with a mass (71.4%) and abdominal pain (38%).
- 12 patients (57%) presented with hepatomegaly and a palpable mass; 3 had concurrent pulmonary and brain involvement.
- No deaths occurred, but 5 children experienced post-operative complications. Primary closure without drainage was associated with better outcomes.
Conclusions:
- Surgical treatment of pediatric liver hydatid disease can be performed with no mortality.
- Primary closure of the cyst cavity without drainage is suggested as the optimal surgical option for large hydatid cysts.
- Further research into standardized surgical protocols for pediatric hydatid disease is warranted.
Abstract:
Between 1986 and 1997, 21 children (ten boys and 11 girls) had surgery for hydatid disease of the liver. Their mean age was 6.5 years (range 3-12). Abdominal distention with a mass was the commonest presenting symptom (71.4%), followed by abdominal pain (38%). Hepatomegaly with a palpable mass was present in 12 (57%). Three children had concomitant pulmonary and brain hydatid disease. The diagnosis was established clinically and by skin testing, serology and imaging techniques. All patients received a pre-operative course of mebendazole (50 mg/kg/day) for between 1 and 8 weeks. At surgery, 11 children had a single cyst, eight of which were in the right lobe of the liver. Ten children had multiple cysts occupying both liver lobes. Three forms of surgical treatment were used: capitonnage + partial excision of fibrous capsule; total excision of the cyst; and external drainage of the cyst cavity. Three children required re-operation. Mean follow-up time was 24 months. There were no deaths, but five children developed post-operative complications. Surgical treatment in the form of primary closure of the cyst cavity without drainage seems to offer the best therapeutic option for patients with large hydatid cysts.