World Journal of Surgery

, Volume 33, Issue 6, pp 1266–1273 | Cite as

Management of Cystic Echinococcosis Complications and Dissemination: Where is the Evidence?

  • Chadli Dziri
  • Karim Haouet
  • Abe Fingerhut
  • Abdeljelil Zaouche


This systematic review was designed to provide “evidence-based” answers to identify the best treatment for a complicated hydatid cyst of the liver and the appropriate management of disseminated cystic echinococcosis. An extensive electronic search of the relevant literature was performed using Medline and the Cochrane Library. This systematic review enabled us make to determine the best treatment options for the following conditions. Liver hydatid cysts ruptured into the biliary tract: Common bile duct exploration should be conducted using intraoperative cholangiography and choledoscopy. When the biliary tract is cleared of all cystic content, T-tube drainage should be sufficient. The principal difficulty concerned the management of the large biliocystic fistula: suture or internal transfistulary drainage or fistulization. Medical treatment is indicated in association with surgery for 3 months postoperatively. During the preoperative period, endoscopic retrograde cholangiopancreatography (ERCP) combined with preoperative endoscopic sphincterotomy (ES) may decrease the incidence of postoperative external fistula. Liver hydatid cysts involving the thorax: An abdominal approach is mandatory when common bile duct drainage is required, and it may be sufficient to treat a direct rupture into bronchi. An acute abdomen, owing to Liver hydatid cysts ruptured into peritoneum, requires an emergent operation. Medical treatment should be associated. Cystic echinococcosis of the lung: Surgery is still the main therapeutic option to remove the cyst, suture bronchial fistula if necessary, followed by capitonnage. Osseous cystic echinococcosis: Wide surgical excision is recommended. Cystic echinococcosis of the heart: Cystopericystectomy is the “gold standard” procedure but is sometimes unsuitable for particular sites. Cystic echinococcosis of the kidney: Cystectomy with pericystectomy is feasible in 75% of cases; nephrectomy must be reserved for destroyed kidney. Multiple associated cystic echinococcosis locations: Complicated cysts should be treated with high priority. In case of several cysts in the liver, spleen, and peritoneum, removal of all cysts in the same intervention is indicated when there is no threat to the life of the patient. Otherwise, a planned reoperation should be considered.


  1. 1.
    ARC, AURC, ACAPEM, Chipponi J, Huguier M (1986) Les kystes hydatiques du foie opérés en France: épidémiologie, attitudes diagnostiques et thérapeutiques: étude de 306 cas. Gastroentérol Clin Biol 10:419–423Google Scholar
  2. 2.
    Bchir A, Hamdi A, Jemni L, Dazza MC, Allegue M, Braham MS, Prazuck T, Achoux M, Gaudebout C, Rousset JJ, Jemmali M, Larouze B (1988) Serological screening for hydatidosis in households of surgical cases in central Tunisia. Ann Trop Med Parasitol 82:271–273PubMedGoogle Scholar
  3. 3.
    Anderson FL (1997) Introduction to cystic echinococcosis and description of cooperative research project in Morocco. In: Anderson FL, Ouhelli H, Kachani M (eds) Compendium on cystic echinococcosis in Africa and Middle Eastern countries with special reference to Morocco. Brigham Young University, Provo, UT, pp 1–17Google Scholar
  4. 4.
    Hsairi M, Chahed MK, Bchir A, Dammak J, Kilani T, Kebir A, Kamel N, Dziri C, Sidhom M (1995) Incidence chirurgicale de l’hydatidose en Tunisie (1988–92). Tunisie Chirurgicale 4:20–26Google Scholar
  5. 5.
    Zaouche A (1994) La chirurgie des kystes hydatiques du foie, Tunis, Société Tunisienne de Chirurgie 28–190Google Scholar
  6. 6.
    Zaouche A, Haouet K, Jouini M, El Hachaichi A, Dziri C, Association TunisianSurgical (2001) Management of liver hydatid cysts with large biliocystic fistula: multicenter retrospective study. World J Surg 25:28–39PubMedCrossRefGoogle Scholar
  7. 7.
    Kilani T, El Hammami S, Horchani H, Ben Miled-Mrad K, Hantous S, Mestiri I, Sellami M (2001) Hydatid disease of the liver with thoracic involvement. World J Surg 25:40–45PubMedCrossRefGoogle Scholar
  8. 8.
    Gharbi HA, Hassine W, Brauner MW, Dupuch K (1981) Ultrasound examination of the hydatic liver. Radiology 139:459–463PubMedGoogle Scholar
  9. 9.
    Cook DJ, Guyatt GH, Laupacis A, Sackett DL (1992) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102(4 Suppl):305S–311SPubMedCrossRefGoogle Scholar
  10. 10.
    Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95(2 Suppl):2S–4SPubMedCrossRefGoogle Scholar
  11. 11.
    Bedirli A, Sakrak O, Sozuer EM, Kerek M, Ince O (2002) Surgical management of spontaneous intrabiliary rupture of hydatid liver cysts. Surg Today 32:594–597PubMedCrossRefGoogle Scholar
  12. 12.
    Köksal N, Muftuoglu T, Gunerhan Y, Uzun MA, Kurt R (2001) Management of intrabiliary ruptured hydatid disease of the liver. Hepatogastroenterology 48:1094–1096PubMedGoogle Scholar
  13. 13.
    Daali M, Fakir Y, Hssaida R, Hajji A, Hda A (2001) Hydatid cysts of the liver opening in the biliary tract. Report of 64 cases. Ann Chir 126:242–245PubMedCrossRefGoogle Scholar
  14. 14.
    Tacyildiz I, Aldemir M, Aban N, Keles C (2004) Diagnosis and surgical treatment of intrabiliary ruptured hydatid disease of the liver. S Afr J Surg 42:43–46PubMedGoogle Scholar
  15. 15.
    Chautems R, Bühler LH, Gold B, Giostra E, Poletti P, Chilcott M, Morel P, Mentha G (2005) Surgical management and long-term outcome of complicated liver hydatid cysts caused by echinococcus granulosus. Surgery 137:312–316PubMedCrossRefGoogle Scholar
  16. 16.
    Jabbour N, Shirazi SK, Genyk Y, Mateo R, Pak E, Cosenza DC, Peyré CG, Selby RR (2002) Surgical management of complicated hydatid disease of the liver. Am Surg 68:984–988PubMedGoogle Scholar
  17. 17.
    Galati G, Sterpetti AV, Caputo M, Adduci M, Lucandri G, Brozzetti S, Bolognese A, Cavallaro A (2006) Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. Am J Surg 191:206–210PubMedCrossRefGoogle Scholar
  18. 18.
    Saritas U, Parlak E, Akoglu M, Sahin B (2001) Effectiveness of endoscopic treatment modalities in complicated hepatic hydatid disease after surgical intervention. Endoscopy 33:858–863PubMedCrossRefGoogle Scholar
  19. 19.
    Ozaslan E, Bayractar Y (2002) Endoscopic therapy in the management of hepatobiliary hydatid disease. J Clin Gastroenterol 35:160–174PubMedCrossRefGoogle Scholar
  20. 20.
    Simsek H, Ozaslan E, Sayek I, Savas C, Abbasoglu O, Soylu AR, Balaban Y, Tatar G (2004) Diagnostic and therapeutic ERCP in hepatic hydatid disease. Curr Gastroenterol Rep 6:272Google Scholar
  21. 21.
    Gerazounis M, Athanassiadi K, Metaxas E, Athanassiou M, Kalantzi N (2002) Bronchobiliary fistula due to echinococcosis. Eur J Cardiothorac Surg 22:306–308PubMedCrossRefGoogle Scholar
  22. 22.
    Kabiri EH, El Maslout A, Benosman A (2001) Thoracic rupture of hepatic hydatidosis (123 cases). Ann Thorac Surg 72:1883–1886PubMedCrossRefGoogle Scholar
  23. 23.
    Athanassiadi K, Kalavrouziotis G, Loutsidis A, Bellenis I, Exarchos N (1998) Surgical treatment of echinococcosis by transthoracic approach: a review of 85 cases. Eur J Cardiothorac Surg 14:134–140PubMedCrossRefGoogle Scholar
  24. 24.
    Sakhri J, Ben Ali A, Letaief R, Derbel F, Dahmen Y, Ben Hadj Hmida R (1996) Hydatid cysts of the liver ruptured into the thorax. Diagnostic and therapeutic aspects. J Chir (Paris) 133:437–441Google Scholar
  25. 25.
    Tocchi A, Mazzoni G, Miccini M, Drumo A, Cassini D, Colace L, Tagliacozzo S (2007) Treatment of hydatid bronchobiliary fistulas: 30 years of experience. Liver Int 27:209–214PubMedCrossRefGoogle Scholar
  26. 26.
    Derici H, Tansug T, Reyhan E, Bozdag AD, Nazli O (2006) Acute intraperitoneal rupture of hydatid cysts. World J Surg 30:1879–1883PubMedCrossRefGoogle Scholar
  27. 27.
    Di Cataldo A, Lanteri R, Caniglia S, Santangelo M, Occhipinti R, Li Destri G (2005) A rare complication of the hepatic hydatid cyst: intraperitoneal perforation without anaphylaxis. Int Surg 90:42–44PubMedGoogle Scholar
  28. 28.
    Larbi N, Hedfi S, Selmi M, Ben Salah K (2002) Acute intraperitoneal rupture of liver hydatid cysts. Ann Chir 127:487–488PubMedCrossRefGoogle Scholar
  29. 29.
    El Malki HO, El Mejdoubi Y, Mohsine R, Ifrine L, Belkouchi A (2006) Intraperitoneal perforation of hepatic hydatid cyst. Gastroenterol Clin Biol 30:1214–1216PubMedCrossRefGoogle Scholar
  30. 30.
    Prousalidis J, Tzardinoglou E, Kosmidis C, Katsohis K, Aletras O (1999) Surgical management of calcified hydatid cysts of the liver. HPB Surg 11:253–259PubMedCrossRefGoogle Scholar
  31. 31.
    Kouskos E, Chatziantoniou J, Chrissafis I, Anitsakis C, Zamtrakis S (2007) Uncommon locations of hydatid cysts. Singapore Med J 48:e119PubMedGoogle Scholar
  32. 32.
    Moumen M, El Aloui M, Mokhtari M, El Fares F (1991) Pour un traitement conservateur du kyste de la rate. J Chir 128:260Google Scholar
  33. 33.
    Lacombe M (1983) Conservation de la rate dans la chirurgie du kyste hydatique splénique. Presse Med 12:1547PubMedGoogle Scholar
  34. 34.
    Narasimharao KL, Venkateswarluk K, Mitta SK, Metha S (1987) Hydatid disease of spleen treated by enucleation and splenic salvage. J Pediatr Surg 22:138PubMedCrossRefGoogle Scholar
  35. 35.
    Mzabi R, Dziri C (1990) Les échinococcoses extrahépatiques: diagnostic et traitement. Revue du Praticien 40:220–224PubMedGoogle Scholar
  36. 36.
    Ramos G, Orduna A, Garcia-Yuste M (2001) Hydatid cyst of the lung: diagnosis and treatment. World J Surg 25:46–57PubMedCrossRefGoogle Scholar
  37. 37.
    Dakak M, Genç O, Gürkök S, Gözübüyük A, Balkanli K (2002) Surgical treatment for pulmonary hydatidosis (a review of 422 cases). J R Coll Surg Edinb 47:689–692PubMedGoogle Scholar
  38. 38.
    Kurul IC, Topcu S, Altinok T, Yazici U, Tastepe I, Kaya S, Cetin G (2002) One-stage operation for hydatid disease of lung and liver: principles of treatment. J Thorac Cardiovasc Surg 124:1212–1215PubMedCrossRefGoogle Scholar
  39. 39.
    Ulkü R, Yilmaz HG, Onat S, Ozçelik C (2006) Surgical treatment of pulmonary hydatid cysts: report of 139 cases. Int Surg 91:77–81PubMedGoogle Scholar
  40. 40.
    Zlitni M, Ezzaouia K, Lebib H, Karray M, Kooli M, Mestiri M (2001) Hydatid cyst of bone: diagnosis and treatment. World J Surg 25:75–82PubMedCrossRefGoogle Scholar
  41. 41.
    Awasthy N, Chand K (2005) Primary hydatid disease of the spine: an unusual case. Br J Neurosurg 19:425–427PubMedCrossRefGoogle Scholar
  42. 42.
    Sarkis A, Ashoush R, Alawi A, Haddad A, Jebara V, Checrallah E (2001) Hydatid cyst of the heart simulating coronary ischemia. Ann Cardiol Angeiol 50:206–210CrossRefGoogle Scholar
  43. 43.
    Gürbüz A, Tetik O, Yilik L, Emrecan B, Ozsöyler I, Ozbek C (2003) Cardiac involvement of hydatid disease. Jpn J Thorac Cardiovasc Surg 51:594–598PubMedCrossRefGoogle Scholar
  44. 44.
    Thameur H, Abdelmoula S, Chenik S, Bey M, Ziad M, Mestiri T, Mechmeche R, Chaouch H (2001) Cardiopericardial hydatid cysts. World J Surg 25:58–67PubMedCrossRefGoogle Scholar
  45. 45.
    Zmerli S, Ayed M, Horchani A, Chami I, El Ouakdi M, Ben Slama MR (2001) Hydatid cyst of the kidney: diagnosis and treatment. World J Surg 25:68–74PubMedCrossRefGoogle Scholar
  46. 46.
    Turgut M (2001) Intracranial hydatidosis in Turkey: its clinical presentation, diagnostic studies, surgical management, and outcome. A review of 276 cases. Neurosurg Rev 24:200–208PubMedCrossRefGoogle Scholar
  47. 47.
    Petigny A, Savoye B, Vilain C, Boulez J, Girard M, Prud’hon MC (1980) Multiple hydatidosis: hepatic, splenic, peritoneal and gynaecologic locations. Sem Hop 56:685–687PubMedGoogle Scholar
  48. 48.
    Feki W, Ghozzi S, Khiari R, Ghorbel J, Elarbi H, Khouni H, Ben Rais N (2008) Multiple unusual locations of hydatid cysts including bladder, psoas muscle and liver. Parasitol Int 57:83–86PubMedCrossRefGoogle Scholar
  49. 49.
    Dhaliwal RS, Kalkat MS (1997) One-stage surgical procedure for bilateral lung and liver hydatid cysts. Ann Thorac Surg 64:338–341PubMedCrossRefGoogle Scholar
  50. 50.
    Ceran S, Sunam GS, Gormus N, Solak H, Sahin M (2002) Cost-effective and time-saving Surgical treatment of pulmonary hydatid cysts with multiple localization. Surg Today 32:573–576PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Chadli Dziri
    • 1
  • Karim Haouet
    • 2
  • Abe Fingerhut
    • 3
  • Abdeljelil Zaouche
    • 4
  1. 1.General Surgery BHôpital Charles NicolleTunisTunisia
  2. 2.Emergency DepartmentHôpital Charles NicolleTunisTunisia
  3. 3.General Surgery, Service de Chirurgie visceraleCentre hospitalier Intercommunal Poissy PoissyFrance
  4. 4.General Surgery AHôpital Charles NicolleTunisTunisia

Personalised recommendations