Case of takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst: A case report

BACKGROUND Takotsubo cardiomyopathy,also called apical ballooning syndrome,is a disease that is often triggered by stress factors in postmenopausal women and mimics acute coronary syndrome.The aim of this article is to draw attention to takotsubo cardiomyopathy after surgical treatment of liver hydatid cyst.CASE SUMMARY A 50-year-old diabetic and hypertensive female patient was evaluated preoperatively before general surgery for liver hydatid cyst,and no cardiac problems were found.The patient was discharged on the 3rd postoperative day without any postoperative complications.On postoperative day 5,the patient presented to the emergency department with fever,shortness of breath,chills,and shivering and was hospitalized with the diagnosis of pneumonia.The troponin levels remained high during follow-up.Echocardiography was performed on postoperative day 7,after which the patient was referred to a tertiary center with the diagnosis of non-ST-elevation myocardial infarction due to akinesia in the apical region.Coronary angiography performed at the tertiary center showed normal coronary anatomy,and the patient was diagnosed with takotsubo cardiomyopathy.CONCLUSION Takotsubo cardiomyopathy mimicking myocardial infarction without ST segment elevation may develop after surgical treatment of liver hydatid cyst.

Hydatid Cyst of the Liver: About a Case at the Digestive and General Surgery Department of the University Hospital of Bouaké(Côte d’Ivoire)

Hydatid cyst of the liver (KHF) is a parasitic condition caused by the development of the larval form of the dog tapenia Echinococcus granulosus. In sub-Saharan Africa, few writings are interested in this pathology, which remains common and constitutes a public health problem in highly endemic countries [1] [2]. We report the observation of a 61-year-old hypertensive patient owner of a dog admitted for abdominal pain without abdominal mass. In whom ultrasound and computed tomography have made it possible to make the diagnosis of hydatid cyst of the liver (KHF). The patient underwent surgery. We performed an associated conservative treatment post-operative albendazole. The post-operative follow-up was simple. In our patient the evolution was good after a setback of more than 2 months. Through this observation and a review of the literature, we insist on the contribution of imaging in diagnosis and treatment, which is essentially surgical.

Review of the treatment of liver hydatid cysts

A review was carried out in Medline,LILACS and the Cochrane Library.Our database search strategy included the following terms: "hydatid cyst","liver","management","meta-analysis" and "randomized controlled trial".No language limits were used in the literature search.The latest electronic search date was the 7th of January 2014.Inclusion and exclusion criteria: all relevant studies on the assessment of therapeutic methods for hydatid cysts of the liver were considered for analysis.Information from editorials,letters to publishers,low quality review articles and studies done on animals were excluded from analysis.Additionally,well-structured abstracts from relevant articles were selected and accepted for analysis.Standardized forms were designed for data extraction; two investigators entered the data on patient demographics,methodology,recurrence of HC,mean cyst size and number of cysts per group.Four hundred and fourteen articles were identified using the previously described search strategy.After applying the inclusion and exclusion criteria detailed above,57 articles were selected for final analysis: one meta-analysis,9 randomized clinical trials,5 non-randomized comparative prospective studies,7 non-comparative prospective studies,and 34 retrospective studies(12 comparative and 22 noncomparative).Our results indicate that antihelminthic treatment alone is not the ideal treatment for liver hydatid cysts.More studies in the literature support the effectiveness of radical treatment compared with conservative treatment.Conservative surgery with omentoplasty is effective in preventing postoperative complications.A laparoscopic approach is safe in some situations.Percutaneous drainage with albendazole therapy is a safe and effective alternative treatment for hydatid cysts of the liver.Radical surgery with preand post-operative administration of albendazole is the best treatment option for liver hydatid cysts due to low recurrence and complication rates.

Predisposing factors and surgical outcome of complicated liver hydatid cysts

AIM: To evaluate the predisposing factors for peritoneal perforation and intrabiliary rupture and the effects of these complications on surgical outcome in liver hydatid disease.METHODS: A total of 372 patients with liver hydatid cysts who had undergone surgical treatment were evaluated retrospectively. Twenty eight patients with peritoneal perforation, 93 patients with spontaneous intrabiliary perforation, and 251 patients with noncomplicated hydatid cysts were treated in our clinics.RESULTS: When the predisposing factors for complications were evaluated, younger age, superf icial position, and larger cyst dimensions (P < 0.05; range, 0.0010.017) increased peritoneal perforation rates. It was shown that older age increased cyst dimensions, and presence of multiple and bilobar cysts increased intrabiliary rupture rates (P < 0.05; range, 0.0010.028). Partial pericystectomy and drainage was the most frequent surgical procedure in all groups (71.6%). The incidence of postoperative complications in the peritoneal perforated group, in the intrabiliary ruptured group, and in the noncomplicated group was 25%, 16.1% and 5.5%, respectively. When compared, complication rates were significantly different (P = 0.002). When length of hospital stay was compared, there was no signif icant difference between the groups (P > 0.05). The overall recurrence rate was 3.8% (14 patients), but there was not any statistical difference among the patient groups (P = 0.13). The early postoperative mortality rate was 1.1%. CONCLUSION: In peritoneally perforated and intrabiliary ruptured cases, the most important steps are irrigation of the peritoneal cavity and clearance of the cystic material from the biliary tree.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts

AIM To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease. METHODS Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years(range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes inthe cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays. RESULTS The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo(range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination(P = 0.384, 0.069, 0.215 and 0.533, respectively). CONCLUSION There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

Treatment of liver hydatidosis:How to treat an asymptomatic carrier?

Liver hydatidosis is the most common clinical presentation of cystic echinococcosis(CE).Ultrasonographic mass surveys have demonstrated the true prevalence,including the asymptomatic characteristic of the majority of cases,providing new insight into the natural history of the disease.This raises the question of whether to treat or not to treat these patients,due to the high and unsuspected prevalence of CE.The high rate of liver/lung frequencies of cyst localization,the autopsy findings,and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion.The decision to treat an asymptomatic patient by surgery,albendazole,or puncture aspiration injection and reaspiration or to wait and watch,is based on conflicting reports in the literature,the lack of complications in untreated patients over time,and the spontaneous disappearance and involution of cysts.All these points contribute to difficulties of individual clinical decisions.The patients should be informed of the reasons and the risks of watchful/waiting without treatment,the possibility of complications,and the risks of the other options.As more information on the natural history of liver hydatidosis is acquired,selection of the best treatment will be come easier.Without this knowledge it would be very difficult to establish definitive rules of treatment.At present,it is possible to manage these patients over time and to wait for the best moment for treatment.Followup studies must be conducted to achieve this objective.

Rare cystic liver lesions: A diagnostic and managing challenge

Cystic formations within the liver are a frequent finding among populations.Besides the common cystic lesions,like simple liver cysts,rare cystic liver lesions like cystadenocarcinoma should also be considered in the differential diagnosis.Thorough knowledge of each entity’s nature and course are key elements to successful treatment.Detailed search in PubMed,Cochrane Database,and international published literature regarding rare cystic liver lesions was carried out.In our research are included not only primary rare lesions like cystadenoma,hydatid cyst,and polycystic liver disease,but also secondary ones like metastasis from gastrointestinal stromal tumors lesions.Up-to date knowledge regarding diagnosis and management of rare cystic liver lesions is provided.A diagnostic and therapeutic algorithm is also proposed.The need for a multidisciplinary approach by a team including radiologists and surgeons familiar with liver cystic entities,diagnostic tools,and treatment modalities is stressed.Patients with cystic liver lesions must be carefully evaluated by a multidisciplinary team,in order to receive the most appropriate treatment,since many cystic liver lesions have a malignant potential and evolution.

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination with cleaning of the abdominal cavity was performed.The patient rapidly improved and no relapse occurred during a follow-up of 8 months.Anaphylaxis is a serious complication of hydatid cyst rupture and needs to be promptly diagnosed.The main objective of our report is to underscore this life-threatening complication that should be considered when anaphylactic shock of unknown origin occurs,even in non-endemic regions.Moreover,we emphasize the need for a radical surgical approach to avoid widespread dissemination.

Radical versus conservative surgical treatment of liver hydatid cysts： a meta-analysis

To date, the efficacy of radical surgery （RS） versus conservative surgery （CS） for liver hydatid cysts （LHC） remains controversial. This meta-analysis was conducted to compare the two interventions. PubMed, Embase, and Web of Science were searched from their inceptions until June 2016. Meta-analysis was performed using STATA 12.0 software. We identified 19 eligible studies from 10 countries by retrieval. In total, 1853 LHC patients who received RS were compared with 2274 patients treated by CS. The risk of postoperative overall complication, biliary fistula, and recurrence was significantly lower, and operation time was significantly longer in the RS group. However, no statistically significant differences were found in terms of mortality risk and the duration of hospital stay between RS and CS. No significant publication biases were observed in all the above analyses. In conclusion, RS reduces the rates of postoperative complications and recurrence, whereas no trend toward such a reduction in mortality was observed in LHC patients.

泡球蚴感染对小鼠肝脏TRIF/IRF3通路和IFITM3的影响

目的探索泡球蚴感染后不同时间对小鼠肝脏β干扰素TIR结构域衔接蛋白(TRIF)/干扰素调节因子3(IRF3)通路及干扰素诱导的跨膜蛋白3(IFITM3)的影响。方法对泡型包虫病患者和其他非感染性肝病(肝血管瘤)手术患者的肝脏组织进行HE及免疫组织化学染色,观察肝组织病理变化及IFITM3和叉头框蛋白P3(Foxp3)的表达。48只C57BL/6J雌性小鼠随机分为感染组(腹腔感染泡球蚴后8,30,60,90,180 d)和对照组。Masson染色观察小鼠肝脏纤维化病变,Western blot和实时荧光定量PCR检测小鼠肝脏TRIF/IRF3通路、IFITM3和Foxp3变化。结果泡型包虫病患者肝脏病灶周围肝组织排列紊乱,有大量炎性细胞浸润;肝血管瘤患者肝脏组织完整。免疫组化检测结果,泡型包虫病患者IFITM3和Foxp3的表达量高于肝血管瘤患者。Masson染色显示泡球蚴感染导致小鼠肝脏纤维化病变。实时荧光定量PCR结果显示,感染组小鼠肝脏TRIF、IRF3、IFNB1和IFITM3 mRNA表达在感染60 d和90 d时均高于对照组(P<0.05),但感染180 d时TRIF、IFNB1和IFITM3 mRNA表达与对照组比较差异无统计学意义(P>0.05);Foxp 3 mRNA的表达随着泡球蚴感染时间呈先上升后下降再上升的趋势,在感染180 d上升到峰值(P<0.05)。Western blot结果显示,泡球蚴感染小鼠90 d,肝脏TRIF、IRF3、IFITM3蛋白表达量均高于对照组(P<0.05),但感染180 d时与对照组比较差异无统计学意义(P>0.05);在感染90 d和180 d时,Foxp3蛋白表达高于对照组,并在180 d上升到峰值(P<0.05)。结论晚期泡球蚴感染时,小鼠肝脏的TRIF/IRF3通路及IFITM3表达下调,影响了天然免疫的抗病原体功能,抑制宿主发挥抗病原体的作用。

Hepatic cystic echinococcosis:Percutaneous treatment as an outpatient procedure

Objective:To demonstrate utility and safety of the puncture aspiration injection and reospiration(PAIR)technique for outpatients.Methods:Percutaneous treatment with US guidance was applied to 33 patients for 44 cysts.Patients treated with the PAIR technique,were outpatients.PAIR and catheterization technique were evaluated for efficacy and safety of procedure and complication rates.Results:Thirty-five of 44 cysts were treated with the PAIR and 9 of 44 were treated with the catheterization technique.The success rate of the cysts Gharbi type 1(CEI)and type 2(Ct3a)treated with the PAIR technique was 1009.hi the follow up of 9 cysts treated with the catheterization technique,2 of them(22%)developed cyst infection and 1(11%)developed a biliary fistula.Conclusions:The PAIR technique was found to be an effective and safe approach in order to treat Gharbi type 1 and type 2 cysts percutaneously for outpatients.It has a very low complication rate in comparison with the catheterization technique.So every effort should be mode to finish the treatment with PAIR technique.

腹腔镜技术在肝包虫病治疗中的应用

目的:总结腹腔镜治疗肝包虫病的经验,探讨其安全性、可行性及适应证。方法:回顾分析17例腹腔镜治疗肝包虫病患者的临床资料,分别行腹腔镜肝包虫内囊摘除及残腔处理、外囊切除或肝部分切除术。结果:本组除1例中转开腹外余均在腹腔镜下完成手术,平均手术时间约50min,平均出血量约120ml,术后当天患者可下床活动,平均住院6d,术后1例出现胆漏,1例1年后复发,无腹腔种植。结论:严格选择手术适应证,腹腔镜手术治疗肝包虫病安全可行。

超声及声触诊组织量化技术在肝囊肿与囊性肝包虫诊断中的初步应用

目的探讨超声及声触诊组织量化技术（VTQ）在肝囊肿与囊性肝包虫诊断中的应用价值。方法选择48例均进行了常规超声检查的患者,被纳入研究范围：肝脏囊性局灶病变直径〉3cm和深度在4-8cm之间。48例经手术切除或穿刺活检病理证实的肝囊肿及囊型肝包虫,应用超声成像技术检查获得囊肿的声像图特征并采用VTQ检测囊内容物的剪切波速度（Vs）。对每一患者,在触摸组织量化区进行5次测量得到的结果,区分单纯囊肿和肝包虫囊肿。判读方法：5次测量至少有2次获得数值者诊断为肝包虫囊肿;5次测量均为无值者诊断为肝囊肿。结果敏感性、特异性、阳性预测值、阴性预测值和准确性分别为86.7%、83.3%、89.7%、78.9%和85.4%。结论超声及VTQ在肝囊性病变的鉴别诊断中有重要的价值。

腹腔镜下切除肝包虫13例

目的总结腹腔镜下肝包虫切除术的经验,探讨其安全性及其可行性。方法回顾性分析我院13例肝包虫腹腔镜下切除术的临床资料,其中8例行腹腔镜下肝包虫外囊切除,5例行肝部分切除术。结果本组病例均在腹腔镜下完成手术治疗,平均手术时间约90 min,平均出血量约350 ml,术后第2天均下地活动,并进流质饮食,术后平均住院时间5 d,术后无胆漏、出血,无复发及腹腔种植。结论腹腔镜下切除肝包虫安全可行,效果优于内囊摘除加残腔处理。

巨大肝包虫患者行联合肝脏离断和门动脉结扎二步肝切除术的护理配合

目的探讨巨大肝包冲虫病采用联合肝脏离断和门动脉结扎二步肝切除术(ALPPS)的治疗效果。方法对2016年1月8日入住我院1例巨大肝包虫病患者实施ALPPS术。结果首次将ALPPS技术应用于肝脏良性病变的切除,手术非常顺利,并取得很好的治疗效果。结论肺脏良性病变的切除使用ALPPS技术治疗效果更好。

肝包虫病的MRI表现

目的:分析肝包虫病的MRI表现,以提高对其的认识。方法:回顾性分析肝包虫病12例,其中肝细粒棘球蚴8例,肝泡状棘球蚴4例。5例做MRI水成像,4例做血管MRI成像,全部做MRI平扫加增强扫描检查。结果:肝细粒棘球蚴为圆形或类圆形边缘光滑锐利的影像,T1WI呈低信号,T2WI呈高信号,囊壁厚度均匀一致。在T2WI上低信号和多房性子囊为其特征性表现。泡状棘球蚴呈不规则实性肿块,T1WI、T2WI均以低信号为主,尤其是在T2WI上的低信号是其特征性表现。MRCP水成像和MRA血管成像技术的运用,能够清楚显示肝包虫病灶的细微结构、病灶与胆道及病灶与血管的关系。结论:MRI可以检出肝包虫寄生的部位、种类、形态、大小、与邻近器官的关系,对不同病理变化的相应的分型和肝脏非寄生虫性占位病变的鉴别诊断。

胸腔镜与开胸肺包虫内囊摘除术治疗肺包虫病的对照研究

目的探讨电视胸腔镜手术治疗肺包虫的价值。方法回顾性分析1995年6月-2017年3月开展的118例行胸腔镜下肺包虫内囊摘除术和87例开胸肺包虫病手术的患者,收集患者基本信息及手术时间、出血量、留置胸管时间、胸管引流量、疼痛情况、术后漏气、出血、包虫残腔感染、肺部感染、支气管胸膜瘘等资料,并进行对比分析。结果胸腔镜组手术时间105. 18±23. 57min,与开胸组98. 56±11. 37 min无显著差异,但在术中出血(28. 37±6. 85mL vs 91. 47±10. 29mL),胸管引流量(60. 35±21. 31mL vs120. 33±11. 47mL),以及术后住院时间(7. 35±1. 78d vs 10. 14±3. 75d)均有显著优势(P <0. 05)。胸腔镜组在肺部感染率(18,15. 25%)、切口感染率(9,7. 63%)方面明显优于开胸组(分别为23,26. 44%及14,16. 09%),胸腔镜组包虫残腔开放处理并置双引流管组术后漏气发生率(11. 02%)、包虫残腔感染率(5. 93%VS 5. 74%)、支气管胸膜瘘发生率(4. 24%vs 3. 45%)、咯血发生率(6. 78%vs 5. 74%)与传统开胸残腔缝合术后并发症比较均无显著性差异(P>0. 05)。但胸腔镜组术后包裹性液气胸发生率(8. 47%vs 18. 39%)明显降低。结论胸腔镜治疗肺包虫病较开胸治疗安全,有效。

超声及声触诊组织量化技术在囊型肝包虫生物学活力判断中的应用价值

目的探讨超声及声触诊组织量化(VTQ)技术在囊型肝包虫囊肿内容物活性判断中的应用价值。方法通过超声检查和VTQ技术,检测48例经手术病理证实的51个囊型肝包虫囊肿声像图特征及囊内容物的Vs值,并结合病理学检查资料进行比较分析。结果囊型肝包虫超声分型中,内囊分离型和实变型分别与单纯囊肿型和子囊型比较,Vs测量阳性率均增高(P<0.05);无活性原头蚴组Vs测量阳性率比有活性原头蚴组显著增高(P<0.001);病理学分级中,Ⅲ级分别与I级及Ⅱ级比较,Vs测量阳性率均增高(P<0.05);内囊破裂组Vs测量阳性率显著高于内囊完整组(P<0.001)。结论 VTQ技术结合超声声像图,在囊型肝包虫内容物活性预测中具有较高的临床应用价值。

肝包虫术后残腔并发症的防治(附173例报告)

目的讨论肝包虫内囊摘除术后残腔并发症的防治方法。方法回顾分析我院1960年1月至2004年1月肝包虫内囊摘除术后外囊残腔并发症173例,占同期肝包虫手术的17.49%(173/989)。其中残腔感染104例(60.12%),残腔出血2例(1.16%),残腔胆汁漏51例(29.48%),钙化残腔不闭合13例(7.51%),残腔消化道瘘3例(1.73%)。87例(50.29%)经再次手术治疗。结果术后腹腔感染7例(8.05%),伤口感染11例(12.64%),肺部感染4例(4.6%),死亡3例(1.73%)。本组治愈率为98.27%。结论肝包虫内囊摘除术后残腔并发症发生率较高,其中以残腔感染及胆汁漏最为常见,部分病例治疗甚为困难,严重影响病人的生活质量甚至生命。包虫囊肿完整切除可有效地预防术后残腔并发症。近来有人提出包虫外囊与肝组织之间有一层疏松的结缔组织称为“外科膜”,该膜有利于包虫囊肿完整切除。作者认为包虫囊肿完整切除应根据病人的全身及局部情况和术者的经验而定,不可盲目从事。

磁共振平扫及增强扫描对肝包虫病诊断价值

目的：观察肝包虫病在磁共振（ MRI）平扫及增强扫描下的表现,探讨磁共振对肝包虫病的诊断准确率。方法：回顾性分析在我院治疗并且经手术病理证实为肝包虫患者30例,对其术前行MRI检查下表现及诊断阳性率进行分析。结果：在30例患者中,细粒棘球蚴病患者共25例,泡球蚴病患者5例。共发现包虫囊肿53个,病灶大小为1.7~11.7cm,为多房型囊肿42个,单房型囊肿9个。MRI诊断阳性患者29例,其中细粒棘球蚴病24例,泡球蚴病5例,诊断阳性率为96.7%（29/30）。MRI平扫中,囊液T1 WI呈低信号,T2 WI呈高信号,囊壁T1 WI稍高于囊液信号,T2 WI呈相对低信号,囊肿周围肝组织信号无异常,囊腔周围无晕环。增强扫描,仅2例患者包囊囊壁有轻度强化。结论：MRI对肝包虫病诊断价值高,可以清晰显示病变的部位及信号特征,对其定位、定量及定性诊断价值较高,可以作为对肝包虫病的补充诊治手段。