Year
A 6-year-old boy from Jharkand, India with a h/o jaundice for 6 months, abdominal distention for 4 months, and intermittent abdominal pain. O/E he was afebrile, icteric and had hepatosplenomegaly. USS and MRI showed mildly enlarged liver with 1 cm cyst in left lobe, bile duct distended, enlarged spleen and large retro-pancreatic cyst and suspected choledochal cyst. Intra-operatively, large retroperitoneal cyst resected and sent for histopathological examination.
- What is the diagnosis?
- What is the mode of acquisition?
- What is the treatment of choice?
Case answer – Posted on: 15-Nov-2024
- What is the diagnosis?
Hydatid cyst caused by Echinococcus granulosis. The cyst ranges in size from a few millimetres to more than 30 centimetres and filled with hydatid fluid. It consists of three layers: the pericyst, ectocyst, and endocyst. The brood capsules arise from the endocyst and contain protoscolices. Single liver lesions are observed in 75% of cases, with 80% located in the right lobe. The lung is the second most common site, accounting for 15% of cases. In 10% of cases, the spleen, ovary, pancreas, and other structures within the abdominal cavity are involved - What is the mode of acquisition?
Man acquires the infection by the ingestion of food contaminated with dogs faeces containing the Echinococcus egg. Rarely flies serve as mechanical vectors of the egg. - What is the treatment of choice?
This patient had a USG-CE1 stage unilocular anechoic cyst and was treated with PAIR (Puncture, Aspiration, Injection of a scolicidal agent, and Re-aspiration). Antiparasitic therapy with albendazole was administered to prevent recurrence and reduce the size of the cyst prior to the procedure. Albendazole was given at a dose of 15 mg/kg/day in divided doses, starting 1 week before the procedure and continued for 4 weeks afterwards.
References:
- Gomez i Gavara C, López-Andújar R, Belda Ibáñez T, Ramia Ángel JM, Moya Herraiz Á, Orbis Castellanos F, et al. Review of the treatment of liver hydatid cysts. World J Gastroenterol 2015;21:124–31.