Postoperative Morbidity Risk Factors After Conservative Surgery of Hydatic Cyst of the Liver: A Retrospective Study of 151 Hydatic Cysts of the Liver

Background: Hepatic hydatid cyst is an endemic parasitosis in Tunisia. Although most of these cysts are benign; their treatment may lead to several complications which can cause an important post-operative morbidity and mortality.The purpose of the present paper is to assess the morbidity and mortality specifics risk factors of hepatic hydatid cysts after conservative surgery.Methods: We conducted a retrospective study of 102 patients over a period of 13 years, from 2006 to 2019. We included all patients operated on for hydatid cyst of the liver, complicated and uncomplicated, in the Department of General Surgery of Mahdia, Tunisia.We excluded patients who received an exclusive medical treatment and those who have other hydatic cyst localizations.Descriptive statistics,bivariate analysis using chi-squared test and Fisher’s exact test for categorical variables;t-test,ANOVA , and Kruskal–Wallis for continuous variables; odds ratio calculations, ordinal and multivariate logistic regression models were appliedResults: The cohort was composed of 102 patients with a total of 151 cysts operated on using conservative surgery, among them there was 75 women (73, 5%) and 27 men (26.5%). The median age was 43, with extremes ranging from 12 to 88 years. The majority of patients (94. 1%) were from rural areas. The cysts were uncomplicated in about half of the cases (48%), elsewhere complications such as compression of neighboring organs (25,5%), opening in the bile ducts (16,7%), infection (9,8%), and rupture in the peritoneum (2%) were found. Conservative surgery was the mainstay of treatment with an overall mortality rate of 1. 9%. The overall morbidity rate was 22%: 14% specific morbidity and 8% non-specific morbidity. External biliary fistula was the most common postoperative complication (9%). The predictive factors of morbidity in univariate analysis were Preoperative hydatid cyst infection (P = 0.01), Compressive cysts (P=0.05), preoperative fever and jaundice, (respectively P=0. 03 and P=0. 02), no one achieved statistical significance in the multivariate modelConclusions:Preoperative hydatid cyst infection, compressive cysts and preoperative fever and jaundice are significant predictor factors of morbidity after conservative surgery for liver hydatid cyst. They must be considered in the treatment and the surgical decision for patients with hydatid cyst.

HYDATIC CYST OF THE LIVER OR HEPATIC MUCINOUS CYSTADENOMA

Mucinous cystadenomas of the liver are rare cystic neoplasms, often mistaken for simple cysts or hydatid cysts of the liver. They are generally benign tumors, often discovered incidentally on imaging or during independent surgeries. Despite their tendency to grow slowly, mucinous cystadenomas of the liver can reach symptomatic dimensions. And given their potential for malignant transformation into mucinous cystadenocarcinomas, a misdiagnosis can have serious secondary consequences. We report the case of a 55-year-old woman with chronic right hypochondrium pain in whom a mucinous cystadenoma of the liver was accidentally discovered during surgery for hepatic hydatid cyst at the general surgery department at the ARRAZI Hospital - UHC Mohammed VI in Marrakech, Morocco.

An extrahepatic hydatid cyst with the fat-fluid level

A hydatic cyst is a zoonosis caused by the larva of a tapeworm Echinococcus granulosus. The liver is the most commonly affected organ. Soft tissue localization has been reported in 2.3% of cases. Herein, we present a patient with a fat-containing hydatid cyst located in the left thigh. There are only a few reports in the literature on the presence of the fat-fluid level within a hydatid cyst. Previous studies have suggested that fat-containing hydatid cysts occur due to their cysto-biliary communication in the liver. In our case, we describe a fat-containing hydatid cyst in the extrahepatic location and discuss the pathophysiologic mechanism of fat inside it.

HIPERTENSIUNE PORTALĂ STÂNGĂ PRIN CHIST HIDATIC LIENAL

Left portal hypertension, caused by hydatic cyst of spleen is a rare complication. We present the clinical case of a 41 years old patient, diagnosed and surgically managed in our clinic. Positive diagnosis was confirmed by imaging methods and intraoperatively. Splenectomy, associated in postoperative period with antiparasitic medication and β-blockers, had a positive influence over the disease evolution.