Management of hydatidosis in children. Twenty-one year experience

Hydatidosis is a serious problem in non-endemic countries due to the influx of immigrants from nations where preventive measures are inadequate. The aim of this retrospective study is to present our experience in the management of hydatidosis in children and to define the criteria for the most effective model of treatment.

Over a 21-year period (1985 - 2006), 150 children with pulmonary and abdominal hydatidosis (ECHINOCOCCUS CYSTICUS) were treated at our department. The anatomical location of the parasite was as follows: liver 82, lungs 59, spleen 4, mesentery 2, kidneys 2 and pelvic floor 1 case. Medical treatment with oral antihelminthic agents was given to 37 patients (45.1 %), with liver hydatidosis, 36 patients (61 %) with pulmonary hydatidosis and one patient with hydatid cyst of the spleen. The remaining 76 patients were submitted primarily to excision of the cyst or partial capsectomy.

Medical treatment was ineffective in 16 patients (43.2 %) with liver hydatidosis, 11 patients (30.6 %) with pulmonary hydatidosis and one patient with hydatidosis of the spleen. All patients with pulmonary hydatidosis who failed to respond to medical treatment developed complications requiring surgical intervention. Of the 76 patients who were submitted to surgery initially, only 4 (5.3 %) presented with postoperative complications requiring reoperation. In all cases who responded inadequately to medical treatment or developed complications the cyst diameter exceeded 6 cm. The overall long-term results were good.

a) Hydatid cysts with sizes exceeding 6 cm in diameter should not be treated medically; b) medical treatment seems to be more effective for pulmonary hydatidosis but failed medical treatment in these patients leads to complications with increased morbidity; c) large hydatid cysts should be treated surgically from the start.