Mechanical suction through wide bore catheters for nonsurgical management of Gharbi type III hepatic hydatid cysts.

Aim: To present our experience with management of complex hepatic hydatid cysts (Gharbi type III), using percutaneous large bore catheter drainage followed by active mechanical suction of cyst contents. Methods: Eleven patients (6 males and 5 females with a mean age of 43.2 years), with 13 complex Gharbi type III hepatic hydatid cysts were included in the study. Under sonography guidance the complex heterogeneous hepatic hydatid cysts were treated percutaneously using large bore drainage catheter and active mechanical suction. Results: Successful drainage of all 13 complex Gharbi type III hepatic hydatid cysts was achieved in all patients (n = 11). The mean duration of catheter placement was 11.3 days (range 7 to 40 days). The most common problem encountered was biliary fistula (n = 3), which was effectively managed with prolonged catheter drainage and/ or endoscopic intervention. No serious complications or deaths were encountered. Minor complications were seen in 7 patients including, urticaria in 3, fever in 2 and reactive pleural effusion in 3. All patients responded to symptomatic treatment. Follow up serial ultrasound was performed on all patients, that showed near complete healing in 9 and formation of pseudotumour in 4 patients. There was no recurrence with a mean follow up of 15.23 months (6 months – 2 years). Conclusion: Percutaneous suction and large bore catheter drainage of Gharbi type III hepatic hydatid cysts is a safe and effective alternative therapy.

Hydatidiarrhea.

Hydatid cysts rarely rupture into the bowel lumen. We describe five patients presenting with passage of hydatid membranes in stool. Early surgical intervention may prevent erosion of such cysts into the hollow viscus.

Sonographically guided thrombin injection for the treatment of femoral artery pseudoaneurysm.

The formation of pseudoaneurysm in the femoral artery after cardiac catheterization is a well-recognized complication occurring in 1%-4% of cases. It is traditionally managed surgically and has a high morbidity. Prolonged ultrasound-guided compression of the neck of the pseudoaneurysm, and ultrasound-guided injection of thrombin into the aneurysm are newer modalities of treatment especially for small aneurysms. We describe the case of a giant pseudoaneurysm of the right femoral artery, post-arteriography, which was successfully managed with ultrasonographically guided percutaneous thrombin injection.