Alveolar hydatid disease: imaging findings and surgical approach

We report six cases of Alveolar Hydatid Disease (five in the liver and one in the gastrosplenic ligament invading the spleen) in which curative resection of the liver (five cases) and splenectomy (one case) were performed.

The records of the six patients with AHD were retrospectively evaluated. Demographics of the patients, symptoms, laboratory findings, including serology were recorded. Imaging studies determined the extent of the disease preoperatively. Classification of the lesions was done according to the PNM (P = parasitic mass in the liver, N = involvement of neighbouring organs, and M = metastasis) staging system designed by the World Health Organization. All the surgical procedures were performed as complete resections, where negative margins were approved by frozen sections. Chemotherapy with albendazole (10 mg/kg/day) was continued postoperatively for two years in five of the six patients who were alive.

All of the cases were from East Anatolia of Turkey, which is an endemic region. The mean age was 39.6 years (15-54 years). Major complications occurred post-operatively in all patients, possibly due to the extensive resection. No recurrence was seen during the 5 year follow-up of two cases and 2 year follow-up of three cases.

The treatment of Alveolar Hydatid Disease is curative radical resection. Thus, pre-operative imaging studies to determine the extent and stage of the disease are of crucial importance.