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[Juvenile hepatic hydatidosis. Analysis of 40 cases]
Insights
This study presents 40 children with hepatic hydatid disease, highlighting clinical diagnosis and surgical outcomes. The Lagrot technique with routine cholangiography proved effective, showing no mortality and low morbidity.
Area of Science:
- Hepatology
- Parasitology
- Pediatric Surgery
Context:
- Hepatic hydatid disease is a parasitic infection affecting the liver.
- Diagnosis and management in pediatric patients present unique challenges.
- This study reviews a series of pediatric cases to evaluate diagnostic methods and surgical approaches.
Purpose:
- To describe the clinical presentation and diagnostic findings of hepatic hydatid disease in children.
- To evaluate the efficacy of different diagnostic tests, including clinical examination, serology, and imaging.
- To assess surgical outcomes, particularly focusing on the preferred Lagrot technique and its impact on morbidity and mortality.
Summary:
- Forty children with hepatic hydatid disease were analyzed, with clinical diagnosis (palpation, hepatomegaly) being the most frequent initial finding (95%).
- Diagnostic tests showed variable sensitivity: Casoni test (68.57%), antibody investigation (40%), Weinberg reaction (38.70%), and scintigraphy (93.33%). Ultrasonography was definitive in two cases.
- The Lagrot surgical technique with routine surgical cholangiography was favored due to high bile duct involvement (55%), resulting in a short postoperative period (10.3 days), low morbidity (6.25%), and no mortality. No recurrences were observed during 1-14 years of follow-up.
Impact:
- Highlights the importance of clinical suspicion and diagnostic modalities in pediatric hepatic hydatid disease.
- Demonstrates the effectiveness and safety of the Lagrot surgical technique with routine cholangiography in managing complex cases.
- Provides valuable long-term follow-up data, supporting the chosen surgical approach for minimizing complications and ensuring disease eradication.
Abstract:
A series of 40 children (average age 8,7 years) with hepatic hydatic disease is presented. The clinical diagnosis was based on palpation of the tumour and/or hepatomegaly in 95% (38 patients). Other symptoms such as pain, fever and jaundice were less frequent (47,5%, 22,50% and 12,50%, respectively). Other diagnostic tests yielded the following results: the Casoni skin test was positive in 68,57%, the investigation of antibodies in 40% and the Weinberg reaction in 38,70%. The ultrasonography which was carried out only on the last two patients was definitive. The scintigraphy carried out on 30 patients was positive in 93,33%. Due to the polymorphism of the disease all surgical proposals are considered to be initially acceptable. However, the high rate of bile involvement resulting from our experience (55%) has induced us to favour the Lagrot surgical technique with routine surgical colangiography in 16 patients in order to achieve short postoperative periods (10,3 days) and 6,25% of morbidity (one case of biliary fistula). Following all surgical procedures, there was no mortality. No recurrence has been found within a follow-up time ranging from 1 to 14 years.