Quiste hidatídico primario de páncreas: reporte de caso

Introducción. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. Caso Clínico. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. Conclusión. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

Introduction. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. Clinical Case. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. Conclusion. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

Morphology of Echinococcus granulosus protoscolex / Morfología de los Protoescolex de echinococcus granulosus

SUMMARY: Echinococcus granulosus (E. granulosus), is a tapeworm that spreads between intermediate and definitive hosts through the ingestion of fecal matter contaminated with the parasite's eggs. The life cycle consists of differentiation from eggs to oncospheres to embryos, which eventually form cysts in organs like the liver, lungs and others. Within these cysts are protoscolices, an intermediate stage of the parasite which develop into adult tapeworms once they infect their definitive hosts. When these hydatid cysts form in humans, it is known as Cystic Echinococcosis (CE). This disease is treated through surgical excision of the cysts and or chemotherapy with benzimidazole compounds. Understanding the morphology of the intermediate developmental stage of E. granulosus, protoscolex stage, can allow researchers to identify defining structural changes and protein functions that could be used to develop treatment modalities for CE. Unique characteristics in the tegumental surface during the protoescolex stage and proteins associated with cyst fertility have all been identified in previous research studies and bring researchers closer to understanding the underlying mechanisms of E. granulosus development, and consequently, means to disrupt it to achieve better control of the disease.

El Echinococcus granulosus (E. granulosus), es un cestodo que se propaga entre huéspedes intermedios y definitivos a través de la ingestión de materia fecal contaminada con los huevos del parásito. El ciclo de vida consiste en la diferenciación de huevos a oncosferas y embriones, que finalmente forman quistes en órganos como el hígado, los pulmones y otros. Dentro de estos quistes hay protoescólices, una etapa intermedia del parásito que se convierte en su forma adulta (tenia), una vez que infectan a sus huéspedes definitivos. Cuando estos quistes hidatídicos se desarrollan en seres humanos, se les conoce como equinococosis quística (EC). Esta enfermedad se trata mediante la extirpación quirúrgica de los quistes o la quimioterapia con compuestos benzimidazólicos. La comprensión de la morfología de la etapa de desarrollo intermedia del E. granulosus y la etapa de protosclex, puede permitir a los investigadores identificar cambios estructurales definidos y funciones de proteínas que podrían usarse para desarrollar modalidades de tratamiento para la CE. Las características únicas en la superficie tegumentaria durante la etapa de protoescolex y las proteínas asociadas con la fertilidad del quiste se han identificado en estudios de investigación anteriores y acercan a los investigadores a la comprensión de los mecanismos subyacentes del desarrollo del E. granulosus y, en consecuencia, los medios para interrumpirlo para lograr un mejor control de la enfermedad.

Hidatidosis subcutánea primaria

La hidatidosis o equinococosis quística es una zoonosis parasitaria endémica causada por el estadio larvario del cestode Echinococcus granulosus. El hígado y el pulmón son los órganos con afección más frecuente. Su ubicación subcutánea es una entidad rara, poco descrita, y por ende un reto diagnóstico. Describimos el caso de una mujer, de 18 años de edad, procedente de un área endémica, que presentó un quiste hidatídico primario supraclavicular.

Hydatid disease or cystic echinococcosis is an endemic parasitic zoonosis caused by the larval stage of the cestode Echinococcus granulosus, the liver and lung being the most frequently affected organs. Its subcutaneous location is a rare entity, little described, and therefore a diagnostic challenge. We describe the case of an 18-year-old woman from an endemic area who presented with a primary supraclavicular hydatid cyst.

Quiste hidatídico de la glándula tiroides: Reporte de tres casos

Introducción: La enfermedad hidatídica puede desarrollarse en cualquier órgano del cuerpo, siendo las localizaciones más frecuentes el hígado y pulmón, pero ocasionalmente puede afectar a otros órganos como la glándula tiroides. En Chile existen escasas publicaciones previas. El objetivo de este reporte es presentar el diagnóstico, tratamiento y seguimiento de tres pacientes portadores de quiste hidatídico de la glándula tiroides. Casos Clínicos: Se refiere a dos mujeres de 9 y 56 años y un paciente de sexo masculino de 56 años, provenientes de la zona rural de la Región de Aysén en la Patagonia, todos enviados por aumento de volumen sintomático de la glándula tiroides. El diagnóstico presuntivo se realizó mediante los antecedentes anamnésticos e imágenes de ultrasonografía. Todos fueron sometidos a tiroidectomía subtotal y a quimioprofilaxis post operatoria con Albendazol por 30 días. La confirmación diagnóstica se realizó mediante el estudio histopatológico. Ninguno ha presentado recurrencia, llevando una de ellas 22 años de seguimiento. Conclusión: Aunque la glándula tiroides rara vez se ve afectada, la enfermedad hidatídica no debe pasarse por alto en el diagnóstico diferencial de lesiones quísticas de la glándula, especialmente en pacientes que viven en regiones donde la enfermedad es endémica.

Introduction: Hydatid disease can develop in any organ of the body, the most frequent locations being the liver and lung, but occasionally it can affect other organs such as the thyroid gland. In Chile there are few previous publications. Aim: The aim of this report is to present the diagnosis, treatment and follow-up of three patients with hydatid thyroid cysts. Clinical Cases: Two women, ages 9 and 56, and a 56 year old male patient, referred from Aysén in Patagonia, all of them due to a symptomatic increased volume in thyroid gland. The diagnosis was made through anamnestic history and ultrasound images. All underwent subtotal thyroidectomy and postoperative chemoprophylaxis with Albendazole for 30 days. Diagnostic confirmation was made by histopathological study. None had recurrence, one of them has been followed for 22 years. Conclusion: In conclusion, although the thyroid gland is rarely affected, hydatid disease should not be overlooked in the differential diagnosis of cystic lesions of the thyroid gland, especially in patients living in regions where the disease is endemic.

Hidatidosis quística simulando una neoplasia hepática invasiva / Cystic hydatidosis simulating an invasive hepatic neoplasia

La hidatidosis/equinococosis quística es una infección zoonótica, endémica en muchos países de América del Sur, caracterizada por lesiones hepáticas que radiológicamente pueden simular neo-plasias malignas de aspecto quístico y que, dependiendo del tiempo de evolución y del grado de obstrucción de la vía biliar, pueden cursar con insuficiencia hepática, por lo cual es importante un diagnóstico oportuno. Presentamos el caso de un paciente masculino de 35 años, sin antecedentes patológicos de importancia, perteneciente a una comunidad indígena y residente de una zona rural de Colombia, quien presentó un cuadro clínico y pruebas de laboratorio sugestivos de obstrucción de la vía biliar, la cual fue confirmada con el hallazgo de una masa hepática quística infiltrante en los estudios imagenológicos, sospechándose inicialmente una etiología neoplásica maligna. El paciente finalmente falleció tras procedimiento quirúrgico, y su estudio histopatológico reveló una hidatidosis quística como diagnóstico definitivo.

Cystic echinococcosis/hydatidosis is a zoonotic infection, endemic in many South American coun-tries, characterized by liver lesions that radiologically can simulate malignant neoplasms with a cystic appearance, and depending on the time of progression and degree of obstruction of the bile duct, can present with liver failure, so a prompt diagnosis is important. We present the case of a 35-year-old male patient, with no significant pathological history, from an indigenous community and resident of a rural area in Colombia, who presented clinical symptoms and laboratory tests suggestive of bile duct obstruction, which was confirmed with the finding of an infiltrating cystic liver mass in imaging studies, initially suspecting a malignant neoplastic etiology. The patient developed a fulminant course after surgery, and the histopathological study revealed cystic hydatidosis as the definitive diagnosis.

揂ir Bubble Sign� and Fibreoptic Bronchoscopy in Complicated Pulmonary Hydatid Cysts: Steps in the Right Direction

Intact pulmonary hydatid cysts are often discovered incidentally on chest X-rays (CXRs) as rounded opaque lesions with smooth borders. Cyst rupture and infection (complicated hydatid cyst) often change the radiologic appearance delaying diagnosis. Air bubble sign on computed tomography is recognized as a sign of high sensitivity and specificity in the diagnosis of complicated hydatid cysts when compared to other classical radiologic signs. Bronchoscopy is not a preferred investigation in patients with intact hydatid cysts but may have a major role in patients with complicated hydatid cysts with atypical presentation. In the present case series, we attempt to highlight the importance of the 揳ir bubble sign� and the identification of a whitish membrane at bronchoscopy in the diagnosis of complicated hydatid cysts.

Isolated renal hydatid cyst; A rarer infectious disease

Hydatid cyst disease caused by Echinococcus granulosus is commonly seen in the liver but rarely seen in the kidneys, in addition, the isolated renal occurrence is estimated to be about as low as 2–4% of all cases. A 38-year-old male presented with ambiguous left flank pain to the urology clinic. After examination and imaging, he was diagnosed with suspected renal cell carcinoma in the left kidney. Nephrectomy was done and ELISA suggested strongly positive for Hydatid cyst which was later confirmed by histopathological examination. Isolated renal hydatid cyst is an exceedingly rare condition and could possibly be misdiagnosed with other renal masses. The clinical history, laboratory tests, and thorough radiologic imaging are crucial, for accurate preoperative diagnosis as the disease may have no symptoms for years.

Estudio morfocuantitativo de protoescólices y otras estructuras fundamentales de Echinococcus granulosus en hospederos humanos / Morphoquantitative study of protoscolices and other fundamental structures of Echinococcus granulosus in human hosts

La equinococosis quística (EQ) a pesar de ser una enfermedad endémica en diversos lugares del planeta, presenta pocos estudios morfológicos y cuantitativos de las estructuras fundamentales del Echinococcus granulosus en humanos, en especial de los protoescólices. El objetivo de este estudio fue analizar morfocuantitativamente protoescólices y otras estructuras fundamentales de E. granulosus obtenidos de hospederos humanos. Estudio de corte transversal. Se estudiaron 8 especímenes de EQ hepática humana, aplicando un muestreo no probabilístico por conveniencia. Se evaluó las capas quísticas, el líquido y la arenilla hidatídica. Las capas fueron fijadas en formaldehido tamponado a 10 % y procesadas para su inclusión en paraplast. Se realizaron cortes de 5 µm de grosor y fueron teñidas con H-E para su análisis con microscopía óptica. El líquido y arenilla fueron centrifugados y al sedimento obtenido se le realizó análisis directo para determinar las medidas morfométricas de los protoescólices y de los ganchos grandes y pequeños. Se utilizó estadística descriptiva. De los 8 quistes estudiados, 6 eran quistes univesicular, uno multivesicular y un quiste abscedado, cuyas capas laminada y germinativa se encontraban bien definidas. Las vesículas prolígeras presentaban forma redondeada con protoescólices en su interior. Los protoescólices invaginados presentaron un largo y ancho promedio de 140,8 ± 34,3 µm y 106,2 ± 29,5 µm, respectivamente; y los desarrollados un largo de 237,2 ± 53,0 µm y ancho de 128,7 ± 32,0 µm. Los ganchos rostelares presentaron contornos suaves distribuidos en dos filas regulares. El promedio del largo total de los ganchos grandes y pequeños fue 20,1 ± 2,7 µm; el promedio del ancho total fue 7,4 ± 1,2 µm. En conclusión, las características morfocuantitativas de los ganchos de E. granulosus en humanos, son distintos a otras especies hospederas intermediarias y de otros Echinococcus spp. Es posible que el abandono del estado de resistencia de los protoescólices invaginado hasta su desarrollo genere implicancias epidemiológicas de interés.

SUMMARY: Although cystic echinococcosis (CE) is an endemic disease in several parts of the world, few morphological and quantitative studies of the fundamental structures of Echinococcus granulosus in humans, especially protoscolices. The aim of this study was to perform a morphoquantitative analysis of protoescolex and other fundamental structures of E. granulosus from human hosts. Cross- sectional study. Eight human hepatic EQ specimens were studied, applying non-probabilistic convenience sampling. Cystic layers, fluid and hydatid grit were evaluated. The layers were fixed in 10% buffered formaldehyde and processed for embedding in paraplast. Slices of 5 µm thickness were made and stained with H-E for light microscopic analysis. The liquid and grit were centrifuged and the sediment obtained was analyzed directly to determine the morphometric measurements of the protoscolices and the large and small hooks. Descriptive statistics were used. Of the 8 cysts studied, 6 were univesicular cysts, one multivesicular and one abscessed cyst, whose lamellar and germinative layers were well defined. The proligerous vesicles had a rounded shape with protoscolices inside. The invaginated protoscolices had an average length and width of 140.8 ± 34.3 µm and 106.2 ± 29.5 µm, respectively; and the developed ones had a length of 237.2 ± 53.0 µm and width of 128.7 ± 32.0 µm. The rostellar hooks presented smooth contours distributed in two regular rows. The average total length of the large and small hooks was 20.1 ± 2.7 µm; the average total width was 7.4 ± 1.2 µm. In conclusion, the morphoquantitative characteristics of E. granulosus hooks in humans are distinct from other intermediate host species and from other Echinococcus spp. It is possible that the abandonment of the resistance state of the invaginated protoscolices until their development generates epidemiological implications of interest.

Pulmonary tuberculosis with superadded infection of echinococcus and aspergillus

Pulmonary tuberculosis is one of the most common immunosuppressive infections in India, seldom accompanies other parasitic and fungal infections. In our case, we describe the three coexistent infections and their clinical presentation in a 53-year-old woman. A fibro-cavitary lesion in lung with superadded infections of hydatid cyst and aspergillus which is rare has been elaborated in the present case.

Rare Case of Cardiac Hydatitosis and Review of the Literature

Hydatid disease or hydatid cyst results from the tissue development of the hydatid larva of an echinococcus taenia. It is an endemic disease in certain regions of the world such as the Mediterranean basin. We report here the observation of a 39 year old patient with no particular pathological history admitted for pericardial effusion revealing a cardiac hydatid. After clinical and biological explorations we made the diagnosis of a cardiac hydatid located on the inter venticular septum. The patient was put under medical treatment because of the refusal of the surgery

Primary ovarian hydatid cysts: A case series of two cases

Hydatid disease is caused by the adult and the larval stage of tapeworms belonging to the Echinococcus species. The major sites of its infection are the liver and lungs. Rarely, it affects the pelvic region including the ovary, accounting for 0.2–2.25%. The primary ovarian site is a rare finding. We report here a case series of two cases with hydatid cysts as the left ovarian and tubo-ovarian masses. In case 1, a 30-year-old woman complained about lower abdominal pain with swelling and had a 7-month-old child and amenorrhea. Ultrasonographic report exhibited multiple cysts in the ovary. In case 2, a 23-year-old female was having primary left ovarian mass and clinically reported an ovarian dermoid tumor after ultrasound scan and had abdominal lump with pain. Her vital indices were normal. The biopsy was sent for further investigation.

Rare as hen抯 teeth: laparoscopic management of primary pelvic hydatid cyst

Hydatid disease is a zoonotic parasitic disease most frequently caused by echinococcus granulose Primary peritoneal hydatidosisis very rare. We report a case of primary hydatid disease of the intraperitoneal pelvic space.A 22-year-old male patient presented with a history of abdominal pain since 5 months. Abdominal examination revealed a smooth, firm, mildly tender, non-mobile lump in suprapubic region, on digital rectal examination, a smooth spherical mass was felt anteriorly and laterally outside the rectal wall, rectal mucosa was normal. All routine investigations including liver function tests were within normal limits Computed tomography scan of the whole abdomen showed giant cyst of 10� cm with multiple well-defined cysts in rectovesical pouch.Diagnostic laparoscopy was performed. The liver, spleen, mesentery, omentum was found to be normal. A large tense hydatid cyst was noted in the pelvic cavity.Partial peri-cystectomy with endo-cystectomy was performed. Postoperative period was uneventful and patient was discharged on 4th postoperative day.Primary intra-abdominal but extra-peritoneal localization has been reported in only 0.2-2% cases making it a very rare entity.The treatment of choice for pelvic hydatid cyst is principally a careful surgical excision. Here with minimum invasive technique this case was operated and results were excellent

Exosomes and cystic echinococcosis: systematic review / Exosomas y equinococosis quística: revisión sistemática

SUMMARY: Exosomes are small and single-membrane secreted organelles, up to 200 nm in diameter that have the same topology as the cell, but are enriched in proteins, nucleic acids, lipids, and glycoconjugates. It can be found in any type of body fluids such as plasma, urine, saliva, sperm, bile, etc. On the other hand, cystic Echinococcosis (CE) has been studied from different points of view, among others, from genomics and proteomics, and the presence of CE exosomes in humans and other intermediate hosts has been reported in very few articles. The aim of this review was to report the evidence available regarding exosomes and CE. Systematic review. Data sources: Trip Database, SciELO, WoS, MEDLINE, EMBASE and SCOPUS. Eligibility criteria: Studies related to CEin any type of host and state of the parasite, without language restriction, published between 1966-2021. Variables: Year of publication, geographical origin, species isolated, location of exosomes. Forty-two studies were initially identified. After scrutinizing titles and abstracts, checking duplications and in-depth analysis of the studies selected, 12 articles including human, bovine, sheep, dog samples were also included. All were case reports or case series. The highest proportion of articles was published between 2019 and 2021 (58.3 %). Publications were predominantly from China (58.3 %). Evidence about exosomes and CE is scarce and reduced range of articles and cases.

RESUMEN: Los exosomas son orgánulos pequeños y secretados por una sola membrana, de hasta 200 nm de diámetro que tienen la misma topología que la célula, pero están enriquecidos en proteínas, ácidos nucleicos, lípidos y glicoconjugados. Se puede encontrar en cualquier tipo de fluidos corporales como plasma, orina, saliva, esperma, bilis, etc. Por otro lado, la equinococosis quística (CE) ha sido estudiada desde diferentes puntos de vista, entre otros, desde la genómica y proteómica, y la presencia de exosomas de CE en humanos y otros huéspedes intermediarios se ha informado en muy pocos artículos. El objetivo de esta revisión fue informar la evidencia disponible con respecto a los exosomas y la CE. Revisión sistemática. Fuentes de datos: Trip Database, SciELO, WoS, MEDLINE, EMBASE y SCOPUS. Criterios de elegibilidad: Estudios relacionados con la EC en cualquier tipo de hospedador y estado del parásito, sin restricción de idioma, publicados entre 1966-2021. Variables: año de publicación, origen geográfico, especie aislada, ubicación de exosomas. Se identificaron inicialmente 42 estudios. Después de examinar los títulos y resúmenes, verificar las duplicaciones y analizar en profundidad los estudios seleccionados, se incluyeron 12 artículos que incluían muestras de humanos, bovinos, ovinos y caninos. Todos fueron informes de casos o series de casos. La mayor proporción de artículos se publicó entre 2019 y 2021 (58,3 %). Las publicaciones fueron predominantemente de China (58,3 %). La evidencia sobre exosomas y CE es escasa y la gama de artículos y casos es reducida.

Effect of Echinococcus granulosus hydatid cyst fluid protein on allergic rhinitis induced by ovalbumin in mice / 中国血吸虫病防治杂志

Objective To investigate the protective effect of Echinococcus granulosus hydatid cyst fluid protein (HCFP) on ovalbumin (OVA)-induced allergic rhinitis (AR) in mice. Methods Twenty-four BALB/c mice at ages of 8 to 10 weeks, each weighing approximately 20 g, were randomly divided into four groups, including groups A (blank control group), B (blank intervention group), C (AR model group) and D (AR+HCFP intervention group), with 6 mice in each group. On days 0, 2, 4, 6, 8, 10 and 12, mice in groups A, B, C and D were injected with 200 μL sterile phosphate buffered saline (PBS), 200 μL sterile PBS containing 20 μg HCFP, 200 μL sterile PBS containing 50 μg OVA and 5 mg Al(OH)3 gel, and 200 μL sterile PBS containing 50 μg OVA, 5 mg Al(OH)3 gel and 20 μg HCFP, respectively. On days 14 to 20, mice in groups A, B, C and D were administered with 40 μL sterile PBS, 40 μL sterile PBS containing 20 μg HCFP, 40 μL sterile PBS containing 2 mg OVA and 40 μL sterile PBS containing 2 mg OVA and 20 μL HCFP by nasal drop, respectively. Mouse behavioral changes were observed and behavioral scores were estimated. The serum levels of interferon-γ (IFN-γ), interleukin-4 (IL-4), IL-5, IL-10, transforming growth factor-β (TGF-β) and OVA-specific IgE antibody (OVA-sIgE) were measured using enzyme-linked immunosorbent assay (ELISA), and the pathological changes of mouse nasal mucosa were observed by hematoxylin and eosin (HE) staining. Results The mean behavioral score was significantly greater in Group C (6.83 ± 0.50) than in groups A (1.17 ± 0.52) and B (1.33 ± 0.52) (P < 0.05), while a lower mean behavioral score was estimated in Group D (3.50 ± 0.50) than in Group C (P < 0.05). There were significant differences among the groups in terms of serum IFN-γ (F = 4.08, P < 0.05), IL-4 (F = 275.90, P < 0.05), IL-5 (F = 96.82, P < 0.05), IL-10 (F = 77.67, P < 0.05), TGF-β (F = 9.98, P < 0.05) and OVA-sIgE levels (F = 44.69, P < 0.05). The serum IFN-γ level was significantly lower in Group C than in groups A, B and C (P < 0.05), and the serum levels of IL-4, IL-5 and OVA-sIgE were significantly higher in Group C than in groups A, B and C (P < 0.05), while the serum IL-10 and TGF-β levels were significantly greater in Group D than in Group C (P < 0.05). Microscopy showed apparent loss of nasal mucosa cilia, increased number and enlargement of goblet cells, interstitial edema and submucous vascular dilation in Group C, while the pathological changes of nasal mucosa were alleviated in Group D relative to Group C. Conclusions E. granulosus HCFP has a protective activity against OVA-induced allergic rhinitis in mice.

Factores de riesgo para infección en cavidad residual post cirugía de hidatidosis hepática en pacientes de la serranía peruana / Risk factors for infection in the residual cavity after liver hydatidosis surgery in patients from the Peruvian highlands

Resumen Objetivo: Determinar los factores de riesgo a la infección en cavidad residual post quistectomía hepática en los pacientes del hospital Ramiro Prialé Prialé - EsSalud -Huancayo. Materiales y Métodos: Se realizó una cohorte retrospectiva, entre enero del 2014 y enero del 2018. Se utilizó una ficha de recolección de datos. Se obtuvieron los riesgos relativos (RR) crudos y ajustados, con intervalos de confianza al 95%. Resultados: Participaron 83 pacientes. El 41,2% de las mujeres presentaron infección en la cavidad postquistectomía y la mediana de edad de los pacientes infecta dos fue de 33 años. Los antecedentes patológicos que se relacionaron con la infección fueron obesidad o sobrepeso (62,5%), neoplasia previa (100%) y enferme dad inmunológica previa (31%). La infección en cavidad residual postquistectomía estuvo relacionada a la presencia de obesidad o sobrepeso, diabetes mellitus, neoplasia previa , cirugía previa y al uso de antibióticos posteriores a la cirugía. Conclusiones: La obesidad o sobrepeso, diabetes mellitus, haber padecido alguna neoplasia o cirugía previa y el uso de antibióticos luego de la cirugía; son factores de riesgo para la infección en cavidad residual postquistectomía hepática en los pacientes del Hospital Nacional Ramiro Prialé Prialé EsSalud de Huancayo, Perú.

Abstract Objective: To determine the risk factors with the infection in the residual cavity after hepatic cystectomy in the patients of the Ramiro Prialé Prialé hospital - EsSalud -Huancayo. Materials and Methods: A retrospective cohort was conducted, between January 2014 and January 2018. A data collection sheet was used. Crude and adjusted relative risks (RR) were obtained, with 95% confidence intervals. Results: 83 patients participated. 41.2% of women infected in the post-cystectomy cavity and the median age of infected patients was 33 years. The pathological antecedents that were related to the infection were obesity or overweight (62.5%), previous neoplasia (100%) and previous immune disease (31%). Post-cystectomy residual cavity infection was affected by the presence of obesity or overweight (aRR: 1.56; 95% CI: 1.15-2.13; p value = 0.005), diabetes mellitus (aRR: 2.67; 95% CI : 2.09-3.41; p value <0.001), previous neoplasia (aRR: 2.49; 95% CI: 1.94-3.20; p value <0.001), previous surgery (aRR: 1.49; 95% CI: 1.36-1.64; p value <0.001) and the use of post-surgery antibiotics (aRR: 2.14; 95% CI: 1.30-3.51; p value = 0.003) Conclusions: Obesity or overweight, diabetes mellitus, having suffered some neoplasia or previous surgery and the use of antibiotics after surgery; they are factors associated with infection in the residual post-cystectomy liver cavity in patients of the Ramiro Prialé Prialé EsSalud National Hospital in Huancayo, Peru.

Fístula biliobronquial secundaria a quiste hidatídico hepático en tránsito torácico: caso clínico / Bronchobiliary fistula secondary to hepatic hydatid cyst in thoracic transit: clinical case

Resumen Introducción: En un quiste hidatídico hepático pueden ocurrir una serie de complicaciones de diversa gravedad. Una es el tránsito hepatotorácico (THT), que es el compromiso simultáneo de hígado, diafragma y pulmón secundario a migración de un quiste hidatídico hepático. Objetivo: Presentar una complicación de baja incidencia de un quiste hidatídico hepático como lo es el THT con fistula biliobronquial y posterior resolución quirúrgica. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Paciente con diagnóstico de quiste hidatídico en tránsito hepatotorácico con fístula biliobronquial fue sometida a toracotomía, resección en cuña del pulmón incluyendo bronquios comunicantes con el quiste. Paciente presenta evolución clínica e imagenológica favorable. Discusión: Se discuten formas de presentación, complicaciones de la evolución, grados de progresión y ubicaciones anatómicas frecuentes. Se hace énfasis en rol de la clínica e imagenología para diagnóstico y lo controversial del manejo. Conclusión: Tratamiento quirúrgico dependerá de localización de la lesión, estado del quiste, tamaño y experiencia del equipo quirúrgico, siendo una quistectomía con tratamiento de los trayectos fistulosos una buena alternativa.

Introduction: A variety of severe complications can occur in a hepatic hydatid cyst. One of them is the transit from liver to thorax through the diaphragm (HTT). Aim: To present a low impact complication of a hepatic hydatid cyst such as HTT with bronchobiliary fistula and subsequent surgical procedure. Materials and Method: Clinical, imaging, and photographic record of the clinical event. Results: A patient with a diagnosis of hydatid cyst in hepatothoracic transit with bronchobiliary fistula underwent thoracotomy with a wedge resection of the lung, including a cyst-bronchial communication. The patient presents good clinical and imaging evolution. Discussion: Forms of presentation, evolutionary complications, stages of progression, and frequent anatomical locations are discussed. Emphasis is made on the role of the clinical examination and imaging tests for diagnosis and controversial management. Conclusión: Surgical treatment will depend on location of the lesion, experience of the surgical team, condition and size of the cyst, being a cystectomy with the treatment of the fistulous tracts a good alternative.

Metástasis quísticas hepáticas: reporte de caso / Hepatic cystic metastases: case report

RESUMEN En las lesiones quísticas hepáticas múltiples se debe excluir neoplasias metastásicas. Las lesiones metastásicas hepáticas suelen ser hipointensas en T1 e hiper-intensas en T2 en la resonancia magnéticas, hipovasculares, con septos en algunos casos. En un contexto de neoplasia del tracto gastrointestinal acompañado de lesiones quísticas hepáticas, es importante considerar metástasis.

ABSTRACT In multiple cystic liver lesions, metastatic neoplasms should be excluded. Metastatic liver lesions are usually hypointense on T1 and hyperintense on T2 on magnetic resonance imaging, hypovascular, with septa in some cases. In a context of gastrointestinal tract neoplasia accompanied by cystic liver lesions, it is important to consider metastasis.

Enfermedad hidatídica en un paciente con vólvulo de colon transverso estrangulado / Hydatid Disease in a Patient with Strangulated Volvulus of the Transverse Colon

Introducción: La hidatidosis es una zoonosis de distribución mundial con alta incidencia en Argentina, Uruguay, Australia, Grecia y Portugal. Dada la escasa sintomatología que habitualmente produce la enfermedad hidatídica, su diagnóstico se realiza de manera casual por estudios radiológicos fortuitos o durante una laparotomía por otras causas. Por otra parte, la volvulación del colon transverso es un evento raro en la población mundial. Objetivo: Analizar, basados en la literatura relacionada, un caso portador de ambas entidades simultáneamente. Caso clínico: Paciente de sexo masculino de 64 años con condiciones de vida deficientes, que acude a consulta por presentar cuadro clínico de oclusión intestinal mecánica. Los estudios preoperatorios muestran un quiste hidatídico en pulmón derecho. En el acto operatorio se encuentra otro quiste hidatídico en el lóbulo izquierdo del hígado y el colon transverso volvulado como causa de la oclusión. Conclusiones: Pocas veces coinciden 2 condiciones médicas infrecuentes en un mismo paciente. Ambas entidades suponen un reto terapéutico cuando se abordan en situaciones de urgencia como en el reporte. En zonas endémicas debe tenerse una alta sospecha clínica con el fin de obtener un diagnóstico adecuado y poder ofrecer un manejo oportuno. La cirugía, en la mayor proporción de pacientes, es prioritaria(AU)

Introduction: Hydatidosis is a worldwide distribution zoonosis with high incidence in Argentina, Uruguay, Australia, Greece and Portugal. Given the scarce symptoms usually produced by hydatid disease, its diagnosis is made inadvertently by fortuitous radiological studies or during laparotomy for other causes. On the other hand, transverse colon volvulus is a rare event in the world population. Objective: To analyze, based on the related literature, the case of a patient with both entities simultaneously. Clinical case: A 64-year-old male patient with poor living conditions came to the medical office due to a clinical picture of mechanical intestinal obstruction. Preoperative studies show a hydatid cyst in the right lung. During the operative act, another hydatid cyst is found in the left lobe of the liver, apart from the transverse colon volvulus due to the occlusion. Conclusions: Rarely do two infrequent medical conditions coincide in the same patient. Both entities pose a therapeutic challenge when they are approached in emergency situations, as they have been reported here. In endemic areas, a high clinical suspicion must be considered, in order to obtain an adequate diagnosis and be able to offer timely management. Surgery, in the largest proportion of patients, is a priority(AU)

Extra-visceral retroperitoneal echinococcosis: case series with follow-up / Echinococosis retroperitoneal extra-visceral: serie de casos con seguimiento

SUMMARY: Extra-visceral retroperitoneal echinococcosis (EVRE), represents an infrequent condition, even in endemic areas. Its best treatment option is surgery. The aim of this study was to determine postoperative morbidity (POM) and recurrence in patients with EVRE, surgically treated. Case series with follow-up of patients with EVRE undergoing surgery consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2019. The outcome variables were POM and recurrence. Other variables of interest were cyst diameter, surgical time, and hospital stay. Descriptive statistics was used. In this study, 12 patients (75.0 % male), with a median age of 46 years, were treated. The 58.3 % of cases were primary retroperitoneal cysts. The median of cyst diameter, surgical time, and hospital stay were 15 cm, 95 min, and 4 days respectively. The most frequent type of resection was total cystectomy (58.3 %). MPO was 8.3 % (there was urinary infection in one patient). No reoperations were necessary. There was no operative mortality. With a median follow-up of 90 months, a recurrence of 8.3 % was verified (one case). The results achieved, in terms of POM and recurrence were similar to other series.

RESUMEN: La equinococosis retroperitoneal extravisceral (EREV), representa una condición poco frecuente, incluso en áreas endémicas. Su mejor opción de tratamiento es la cirugía. El objetivo de este estudio fue determinar morbilidad postoperatoria (MOP) y recurrencia de pacientes con EREV tratados quirúrgicamente. Serie de casos con seguimiento de pacientes con EREV intervenidos de forma consecutiva en Clínica RedSalud Mayor Temuco, entre 2008 y 2019. Las variables resultado fueron POM y recurrencia. Otras variables de interés fueron diámetro del quiste, tiempo quirúrgico y estancia hospitalaria. Se utilizó estadística descriptiva. Se trató a 12 pacientes (75,0 % hombres), con una mediana de edad de 46 años. El 58,3 % de los casos fueron quistes retroperitoneales primarios. La mediana del diámetro del quiste, tiempo quirúrgico y estancia hospitalaria fueron 15 cm, 95 min y 4 días, respectivamente. El tipo de resección más frecuente fue la quistectomía total (58,3 %). La MPO fue 8,3 % (infección urinaria en un paciente). No hubo reintervenciones ni mortalidad operatoria. Con una mediana de seguimiento de 90 meses, se verificó una recurrencia de 8,3 % (un caso). Los resultados obtenidos, en cuanto a MPO y recurrencia, son similares a otras series.

Hidatidosis esplénica: resultados de una serie de casos consecutiva intervenidos quirúrgicamente / Splenic hydatidosis: results of a series of consecutive cases undergoing surgery

INTRODUCCIÓN: La echinococcosis esplénica (EE), suele ser una enfermedad asintomática cuyo diagnóstico se plantea de forma incidental. OBJETIVO: Determinar morbilidad post-operatoria (MPO) y recurrencia en pacientes intervenidos quirúrgicamente por EE. Material y MÉTODO: Serie de casos con seguimiento, de pacientes con EE intervenidos de forma consecutiva, entre 2000 y 2018. Las variables resultado fueron MPO y recurrencia. Otras variables de interés fueron: diámetro y localización del quiste, tipo de cirugía, tiempo quirúrgico, estancia hospitalaria, y mortalidad. Los pacientes fueron seguidos de forma clínica y con imágenes por un mínimo de 18 meses. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión. RESULTADOS: Se intervinieron 26 pacientes (53,8% hombres), con una mediana de edad de 41,5 años. Las medianas del diámetro de los quistes, el tiempo quirúrgico y el tiempo de hospitalización fueron 14,5 cm; 65 minutos y 4,5 días, respectivamente. La MPO fue 11,5% (3 casos). No hubo mortalidad. Con una mediana de seguimiento de 94 meses, se verificó una recurrencia de 3,8%. CONCLUSIÓN: Los resultados verificados, en términos de MPO, mortalidad y recurrencia son apropiados en comparación a otras series publicadas.

BACKGROUND: Splenic echinococcosis (SE) is usually an asymptomatic disease whose diagnosis is made incidentally. Aim: To determine postoperative morbidity (POM) and recurrence in patients who underwent surgery for SE. METHODS: Case series with follow-up, of patients with SE operated on, consecutively, between 2000 and 2018. The outcome variables were POM and recurrence. Other variables of interest were diameter and location of the cyst, type of surgery, surgical time, hospital stay, and mortality. The patients were followed up clinically and with images for a minimum of 18 months. Descriptive statistics were used, with measures of central tendency and dispersion. RESULTS: Twenty-six patients (53.8% men), with a median age of 41.5 years, underwent surgery in this period. The medians of cysts diameter, surgical time and hospital stay were 14.5 cm, 65 min, and 4.5 days respectively. POM was 11.5% (3 cases). There was no mortality. With a median follow-up of 94 months, a recurrence of 3.8% was verified. CONCLUSION: Verified results, in terms of POM, mortality and recurrence are appropriate in comparison with those of series of similar size and follow-up.