Hydatid Cyst

Hydatid disease is a disease that is caused by a parasite called "Echinococcus" and most commonly affects the liver. Echinococcus subtypes “E. Granulosus” (most common) and “E. Alveolaris” (less common) causes different forms of the same disease. The main host of the parasite is carnivores such as cats and dogs, and the intermediate host is herbivores such as humans or cows. Parasite eggs cannot be broken down in the dog's digestive system and are excreted with feces. Herbivores ingest this egg by mouth or air, and the egg is broken down by deoxycholic acid in the digestive tract, resulting in the parasite. The parasite comes to the liver through the portal circulation system and settles in it. (70%). If the parasite passes through the liver, it reaches the lungs and settles in the lungs. (15%). The disease is found in the brain or other organs at a rate of 5%. It is common in the Far East, South America, the Middle East and the Mediterranean countries.

WHAT IS THE STRUCTURE OF THE HYDATIC CYST?

• The outermost ligament There is pericyst, which consists of tissue.

• Under the pericyst, there is a laminal layer (cuticle)composed of cell-free lipopolysaccharide in the color of egg white.

• The water in the cyst under the cuticle is where (rock water) and scolexs (offspring formed by the cyst to ensure reproduction) are made. germinative membrane(germination membrane).

• In the germinative membrane, there is rock water and scolexs are present.

WHAT ARE THE SYMPTOMS OF HYDATIC CYST?

Hydatid cyst disease is mostly does not cause symptoms. Years after the parasite is removed, a cyst growing in the liver can lead to hepatomegaly (liver enlargement). Growing cyst in right abdomen It can cause pain in the upper quadrant, in some cases it can cause jaundice by pressing on the bile ducts in the liver. If it opens into the bile ducts in the liver, it can cause an allergic reaction-like situation such as jaundice, high fever and chills, shaking, sweating and reddening of the skin. It may also cause symptoms of respiratory distress or indigestion and fullness due to pressure on surrounding organs (lungs, stomach, etc.).

HOW IS HYDATIC CYST DIAGNOSED?

Skin tests

• Casoni test, antigenic cyst fluid is expected to be injected into the skin and cause erythema (redness) on the skin.

• Weinberg test,It is a flocculation test based on "complement fixation".

ELISA test

Immunoelectrophoresis

Imaging

• Direct abdominal radiography and chest radiography, calcifications may be seen,

• Liver scintigraphy, shows that there is a mass in the liver.

• Ultrasonography, Is the mass in the liver cystic? ,solid? It is important in differentiating the cyst, and in addition, it helps up to 100% in making the diagnosis because it shows the germinative membrane and scolex within the cyst. It may be insufficient in cysts smaller than 1 cm.

• Computed tomography and MRI

WHAT ARE THE COMPLICATIONS OF HYDATIC CYST?

• Perforation of the cyst(perforation), rupture of the cyst in the liver due to trauma or other reasons and cause anaphylactic shock. is that it is It can be lethal. If the cyst content spreads in the abdominal cavity, cysts form in the abdomen and the disease may become inoperable.

• Fistulization to the lung, Due to the proximity of the cyst to the chest cavity It is the formation of a fistula (channel) between the lung and the liver (broncho-biliary) as a result of the opening between the lung membranes.

• Obstructive jaundice, compression of the cyst on the bile ducts or It occurs when the cyst opens into the bile ducts and is the most common complication.

• Abscess occurs when the cyst opens into the bile ducts, resulting in its contents being emptied and eventually becoming a liver abscess.

WHAT IS HYDATIC CYST TREATMENT?

The treatment of hydatid cyst disease is medicalandsurgical. .

Drugs called mebendazole or albendazole are used for medical treatment. It is especially started 20 days before the surgery and continued afterwards. It breaks down the germinative membrane and prevents the parasite from using glucose. However, unfortunately, medical treatment is far from being curative “alone”. Generally, its use together with surgical treatment gives good results.

In the surgical treatment of liver hydatid cyst disease, the cyst is emptied, and after it is emptied, various substances are administered into the cyst to prevent recurrence of the disease. Cyst contents should not be transmitted to the environment. The space left after the cyst is removed is filled with different surgical methods.

Surgical surgery options;

• Partial cystectomy + omentopexy The cyst is removed, the space remaining from the cyst is the structure that covers the intra-abdominal organs called omentum. It is filled with omentum and thus the fluids accumulated here are absorbed by the omentum.

• Partial cystectomy + capitonnageThe cyst is removed, the cyst walls are brought together with stitches and the cyst cavity is closed. This prevents the cavity from opening to another organ

• Marsupializationis the mouthing of the cyst onto the skin after the cyst is drained.

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