Peritoneal echinococcosis: anatomoclinical features and surgical treatment

Peritoneal hydatid disease is a rare and poorly known disease. We report our experience with 17 patients treated for peritoneal echinococcosis. The main objectives were to analyze and discuss the specific features of the anatomic peritoneal lesions along with their surgical treatment.

We analyzed retrospectively all patients treated in our unit for peritoneal echinococcosis between January 2001 and December 2008. Preoperative description of the lesions, and the surgical procedures were carefully reported.

Peritoneal hydatidosis represented 6.3% of all abdominal localizations. There were 10 women (58.8%) and 7 men (41.2%). Median age was 34 years. Ten patients (58.8%) had had previous surgery for abdominal echinococcosis. Ten patients (58.8%) had synchronous abdominal localization of hydatid disease, and two patients had synchronous pulmonary localization. Sixteen patients were operated on by laparotomy. We classified the anatomic lesions into four groups: localized form (n = 6, 37.4%), disseminated form (n = 8, 50%), "hydatid carcinomatosis" (n = 3, 18.7%), hydatidoperitoneum (n = 1, 6.25%). One patient had a ruptured hydatid cyst of the left liver. We performed total cystectomies in 10 patients, partial cystectomies in 8 patients, and omentectomy in 5 patients. Two patients (12.5%) had surgical complications. One patient (6.25%) died owing to a pulmonary embolism. Anthelmintic chemotherapy was given to two patients before surgery and to nine patients postoperatively. Recurrences were seen in two patients (14.2%).

Peritoneal echinococcosis can cause a large variety of specific and complex anatomic lesions. The disseminated form is the most common, and therefore the surgical treatment is challenging in most cases.