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Published on: June 16, 2023
Managing multiple hepatic hydatid cysts and a single cardiac hydatid cyst simultaneously through a single surgical
Ahmed Aldolly1, Yousef Alsaffaf1, Saja Karaja1
1Faculty of Medicine, Hama University, Hama, Syria.
Insights
This case study details a novel surgical approach for treating hydatid disease affecting both the liver and heart. The innovative technique successfully managed multiple hepatic and cardiac hydatid cysts in a single operation.
Area of Science:
- Parasitology
- Surgical Innovation
- Hepatobiliary Surgery
Background:
- Hydatid disease, caused by Echinococcus granulosus, poses significant health risks, especially in endemic areas.
- Hepatic hydatid cysts are common, but cardiac involvement, though rare, presents unique management challenges.
- Current surgical strategies for multiorgan hydatid cysts often involve multiple incisions, increasing patient risk.
Observation:
- A 35-year-old woman presented with prolonged abdominal pain.
- Imaging revealed multiple liver hydatid cysts and an asymptomatic intramyocardial cyst.
- The patient received pre- and postoperative albendazole treatment.
Findings:
- A novel, single-stage surgical technique was employed, starting with hepatic cyst removal via a subcostal incision.
- The procedure extended to the thoracic cavity through a diaphragmatic incision for cardiac apex cyst management.
- The patient experienced a successful outcome with no postoperative complications.
Implications:
- This case demonstrates the feasibility and safety of a combined abdominal and thoracic surgical approach for synchronous hepatic and cardiac hydatid cysts.
- The described technique offers a potentially less invasive, single-stage solution for complex hydatid disease.
- This innovative method may improve patient outcomes and reduce morbidity associated with multiorgan parasitic infections.
Introduction And Importance:
Hydatid Disease, primarily caused by the larval stage of the parasite Echinococcus granulosus, represents significant health challenges, particularly in endemic regions. Hepatic cysts are more common, while cardiac involvement is rare.
Case Presentation:
This report presents the case of a 35-year-old woman with atypical abdominal pain persisting for several months. CT scan of the thorax and abdomen revealed multiple hydatid cysts in the liver and a single cyst in the apex of the heart. The intramyocardial cyst was asymptomatic. Albendazole was administered pre- and postoperatively. The surgical approach commenced with the hepatic cysts, accessing the area via a bilateral Kocher subcostal incision in the epigastric region. The second step involved an incision of the central diaphragm, providing clear visualization of the cardiac apex. The operation was successful and the patient was discharged without any complications.
Clinical Discussion:
There are many surgical techniques described in the literature. Recently, single-stage operations have been recommended to manage multiorgan hydatid cysts; however, having two surgical incisions in one operation can still be dangerous to the patient's health.
Conclusion:
To our knowledge, this is the first case that describes a surgical technique that begins in the abdominal cavity and then progresses to the thoracic cavity through the diaphragm to manage both hepatic and cardiac hydatid cysts.
