Primary pancreatic hydatid disease associated with acute pancreatitis

The Editor welcomes submissions for possible publication in the Letters to the Editor section. Letters commenting on an article published in the Journal or other interesting pieces will be considered if they are received within 6 weeks of the time the article was published. Authors of the article being commented on will be given an opportunity to offer a timely response to the letter. Authors of letters will be notified that the letter has been received. Unpublished letters cannot be returned.

Biliary fistula and late recurrence of liver hydatid cyst:Role of cystobiliary communication:A prospective multicenter study

BACKGROUND Hydatid cyst disease(HCD)is common in certain locations.Surgery is associated with postoperative biliary fistula(POBF)and recurrence.The primary aim of this study was to identify whether occult cysto-biliary communication(CBC)can predict recurrent HCD.The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase(ALP)levels in predicting POBF and recurrent HCD.AIM To identify whether occult CBC can predict recurrent HCD.The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.METHODS From September 2010 to September 2016,a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty.Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.RESULTS There was a highly statistically significant association(P≤0.001)between cystic fluid biochemical indices and the development of biliary complications(of 16 patients with POBF,15 patients had high cyst fluid bilirubin and ALP levels),where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications.There was a highly statistically significant association(P≤0.001)between biliary complications,biochemical indices,and the occurrence of recurrent HCD(of 30 patients with recurrent HCD,15 patients had high cyst fluid bilirubin and ALP;all 16 patients who had POBF later developed recurrent HCD),where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts,respectively.CONCLUSION Occult CBC can predict recurrent HCD.Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

A rare case of renal hydatidosis in a child with congenital solitary kidney

Hydatid cyst of a solitary congenital kidney is a rare entity because of the small percentage of cases with renal hvdatidosis and the reduced number of cases with this renal anomaly.We report a case presenting this extremely rare combination and having a favorable outcome.The diagnosis was confirmed based on an association of iniagistic techniques and positive serology.The case was managed using a minimal invasive surgical technique(PAIR) that reduced the operative risks.Additionally,an antihelminthic agent[albendazole) was administered.To our knowledge,this is the first case with such comorbidity and treated through percutaneous approach.

Conquering new battlegrounds:Successful management of isolated giant retrovesical hydatid cyst with robotic assistance

Hydatid disease(HD)is an accidental human parasitic infestation by cestodes and is most commonly caused by Echinococcus granulosus.Liver happens to be the most common site of involvement,although involvement of other organ symptoms is not uncommon.Involvement of the retrovesical pouch by hydatidosis is generally secondary in nature with an incidence of 0.1%-0.5%only.Primary retrovesical hydatid cyst(RVHC)is extremely rare with only few cases in existing literature.RVHC can present with a wide gamut of symptoms ranging from asymptomatic to obstructive uropathy.A 38-year-old male presented to us with complaints of lower urinary tract symptoms(LUTS)and was found to have an isolated primary retrovesical hydatid cyst on evaluation.The RVHC had compressed the right ureter leading to a grossly hydronephrotic non-functional right kidney.The patient was started on albendazole therapy and underwent robot assisted right nephroureterectomy and partial pericystectomy for the RVHC.The postoperative period was uneventful with resolution of symptoms.This report highlights the various clinical presentations of RVHC as well as the minimal invasive management of this rare entity.

Mediastinal and Pericardial Hydatidosis—A Case Report and Review of Literature

Hydatid disease caused by Echinococcus granulosus is endemic in Indian subcontinent and a common surgical problem. Although occurrence of hydatid cyst is common in liver and lungs, it can be encountered in almost every part of the body. Combined mediastinal and pericardial hydatid disease is a rare occurrence and only a few cases have been reported in the literature. Patients with hydatid cysts are usually asymptomatic. Our case report demonstrates a 57-year-old female patient who presented with chest pain and dyspnea on exertion for few months duration. Detailed imaging and laboratory investigation revealed a pericardial and mediastinal hydatid cyst. The patient underwent operation for curative excision. After surgery, the patient’s symptoms resolved and his clinical status improved.

Staged Surgery for Bronchobiliary Fistula and Incidental Finding of Mitral Valve Disease

Bronchobiliary fistula (BBF) is defined as abnormal passage between bronchial system and the bile tree which often manifests as presence of bile in the sputum (biloptysis). BBF is a serious complication which requires early diagnosis and well-planned management strategy to avoid the high morbidity and mortality rate. The hydatid cystic disease is still the leading cause of the BBF. In this paper we present a case of 32-year-old man with BBF who was incidentally found to have a mitral valve disease for which he underwent mitral valve replacement during his management course.

Single Lung Acute Respiratory Distress Syndrome

Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lungs are the second most commonly affected organ after the liver. Intrathoracic and extrapulmonary hydatid disease can affect the pleura, mediastinum, heart, diaphragm, and chest wall. The unusual location or complications of thoracic hydatid disease can present both a diagnostic problem and a therapeutic and surgical problem. We present results of a case of multilocular thoracic hydatid disease complicated by aortic wall erosion and cystic fistula in a 23-year-old patient who developed acute respiratory distress syndrome (ARDS) on the 4th day after emergency pneumonectomy. The surgery was carried out under the conditions of the auxiliary artificial circulation. This case represented a serious clinical situation with the highest risk to life. The need for immediate respiratory support was due to the development of severe respiratory failure, and the presence of direct and indirect harmful factors of ARDS. The correct choice of modes and techniques of mechanical ventilation resulted in significant and sustained improvement in gas exchange parameters without hemodynamic disorders with a further favorable outcome.

Three-dimensional conformal intensity-modulated radiation therapy of left femur foci does not damage the sciatic nerve

During radiotherapy to kill femoral hydatid tapeworms, the sciatic nerve surrounding the focus can be easily damaged by the treatment. Thus, it is very important to evaluate the effects of ra- diotherapy on the surrounding nervous tissue. In the present study, we used three-dimensional, conformal, intensity-modulated radiation therapy to treat bilateral femoral hydatid disease in Meriones meridiani. The focus of the hydatid disease on the left femur was subiected to radio- therapy （40 Gy） for 14 days, and the right femur received sham irradiation. Hematoxylin-eosin staining, electron microscopy, and terminal deoxynucleotidyl transferase-dUTP nick end labeling assays on the left femurs showed that the left sciatic nerve cell structure was normal, with no ob- vious apoptosis after radiation. Trypan blue staining demonstrated that the overall protoscolex structure in bone parasitized with Echinococcus granulosus disappeared in the left femur of the animals after treatment. The mortality of the protoscolex was higher in the left side than in the right side. The succinate dehydrogenase activity in the protoscolex in bone parasitized with Echi- nococcus granulosus was lower in the left femur than in the right femur. These results suggest that three-dimensional conformal intensity-modulated radiation therapy achieves good therapeutic effects on the secondary bone in hydatid disease in Meriones meridiani without damaging the morphology or function of the sciatic nerve.

Multiple recurrent cystic echinococcosis with abdominal aortic involvement: A case report

BACKGROUND Recurrent cystic echinococcosis(CE)with vital organ involvement is a challenge for clinicians.Herein,we report a case of aortic involvement in recurrent retroperitoneal CE lesions following primary splenic CE resection.CASE SUMMARY A 60-year-old male was admitted due to progressive abdominal pain and poor appetite.He was diagnosed with multiple recurrent CE with abdominal aortic involvement according to preoperative evaluation.During surgical resection,major aortic bleeding accidentally occurred while dissecting the cyst,which was firmly attached to the abdominal aortic wall.Hemostasis attempts were conducted to deal with this emergency situation and maintain circulation.Postinterventional recovery was uneventful,and 2-year follow-up showed no sign of recurrence or any other complications.CONCLUSION Radical resection of recurrent complicated CE with aortic involvement should be carefully planned and performed to prevent possible severe adverse complications,thereby improving the postoperative outcome.

Intrabiliary rupture of hepatic hydatid cysts： results of 10 years＇ experience

Intrabiliary rupture （IBR）is the most common and potentially fatal complication of Hepatic cysticechinococcosis （HCE） Early diagnosis and treatment of IBR is very important, since mortality is high when obstruction of the biliary ducts occurs, leading to ascending cholangitis and septicemia.

Primary spinal intradural hydatidosis： a case report

Hydatid disease is a parasitic infestation by a .tapeworm of the genus echinococcus. Spinalhydaticiosis occurs in 1% of all cases with hydatidosis and is most commonly located in the dorsal spine.1 It is a rare cause of neurological signs and symptoms. Spinal hydatid disease should be considered in the differential diagnosis of spinal cord compression syndrome in endemic areas. There are no characteristic signs or symptoms. Misdiagnosis is easily to be made preoperatively. Most diagnosis are made intraoperatively, which increases the risk of future recurrences.