Hidatidosis pancreática en una niña de 5 años / Pancreatic echinococcosis in a 5-year-old girl

La hidatidosis pancreática representa el 0,2-0,6 % de los casos, siendo la población pediátrica la de mayor riesgo. Las lesiones suelen localizarse en cabeza del páncreas (50-58 %); la localización en cuerpo y cola del páncreas se encuentra en el 24-34 % y el 19 %, respectivamente. Dada la posibilidad de complicaciones, suele realizarse tratamiento quirúrgico. Se sugiriere indicar albendazol antes y después del acto quirúrgico por los riesgos de ruptura y diseminación de los protoescólices. Se presenta el caso de una niña de 5 años de edad con dolor abdominal progresivo y lesión quística en páncreas compatible con hidatidosis en la ultrasonografía. En la tomografía computada se observa compresión de la vía biliar. La hemoaglutinación indirecta fue negativa. Presentó elevación de la bilirrubina total, con franco predominio de bilirrubina directa, y aumento de enzimas hepáticas. Se realizó laparotomía exploradora, colecistectomía y destechamiento del quiste. Evolucionó favorablemente, continuó con albendazol durante 3 meses luego de la cirugía.

Pancreatic echinococcosis accounts for 0.2­0.6% of cases, with the pediatric population being at a higher risk. Most commonly, pancreatic lesions occur in the head of the pancreas (50­58%); and in the body and tail in 24­34% and 19% of cases, respectively. Given the potential complications, surgery is usually performed. Albendazole is recommended before and after the surgery due to the risks for rupture and dissemination of protoscolices. Here we describe the case of a 5-year-old girl with progressive abdominal pain and cystic lesion in the pancreas compatible with echinococcosis in the ultrasound. The computed tomography showed bile duct compression. Indirect hemagglutination was negative. She had elevated total bilirubin, with a clear predominance of direct bilirubin, and high liver enzymes. Exploratory laparotomy, cholecystectomy, and unroofing of the cyst were performed. The patient had a favorable course and continued with albendazole for 3 months after the surgery.

A case of echinococcosis in Hunan Province / 中南大学学报(医学版)

Echinococcosis is mainly prevalent in the agricultural and pastoral areas in the northwest of China, but it is relatively rare in Hunan Province. Here, we reported the clinical data of a case of echinococcosis in Hunan Province. The patient was an 11-year-old male, who sought treatment at the Second Xiangya Hospital of Central South University due to abdominal mass. According to the symptoms, signs, and laboratory examinations, he was initially diagnosed as "intra-abdominal mass" and "spleen cyst". Subsequently, he underwent abdominal massive occupying resection and splenectomy. Postoperative pathological examination revealed the cuticle and germinal layer of hydatid and protoscolex, which was consistent with characteristics of echinococcosis. In addition, the serological examination showed that the specific anti-hydatid IgG antibody was positive. Combined with the patient's condition, he was given praziquantel treatment. After a month of follow-up, the patient was asymptomatic.

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.

Quiste hidático primario músculo-esquelético: revisión de la literatura a propósito de un caso / Primary hydatid cyst of skeletal muscle: a literature review based on a case / Cisto hidático primário músculo esquelético: revisão da literatura a propósito de um caso

Resumen: Introducción: la equinococosis quística músculo-esquelética es poco frecuente, pudiendo determinar retrasos diagnósticos y errores terapéuticos. Reporte de caso: presentamos el caso de un paciente con un quiste hidático primario único a nivel de la región femoral posterior derecha, infectado. Discusión: se realizó una revisión en las bases de datos PubMed y LILACS sobre el diagnóstico y manejo terapéutico de los quistes hidáticos músculo-esqueléticos primarios. Conclusiones: la equinococosis quística músculo-esquelética debe ser tenida en cuenta dentro de los diagnósticos diferenciales de tumoraciones de partes blandas en pacientes provenientes de zonas endémicas. La tomografía computada y/o resonancia magnética cumplen un rol diagnóstico y de planificación terapéutica. El tratamiento es quirúrgico, a medida del paciente y del quiste, en función de su topografía, tamaño y fundamentalmente relaciones vasculo nerviosas y musculares. Otros factores a tener en cuenta son las futuras secuelas funcionales y resultados estéticos.

Summary: Introduction: musculoskeletal cystic echinococcosis is rather an unusual condition, what may result in delayed diagnosis and therapeutic mistakes. Case report: the study presents the case of a patient with a single primary hydatid cyst in the right posterior femoral region, which is infected. Discussion: a review of PubMed and LILACS was performed to learn about diagnosis and therapeutic handling of the primary musculoskeletal hydatid cysts. Conclusions: musculoskeletal cystic echinococcosis needs to be considered among differential diagnosis of soft tissues tumors in patients coming from endemic areas. A CT scan and RMI play an important role in diagnosis and the planning of treatment. Treatment involves surgery that must be adapted to the patient and the cyst, considering its topography and size, and in particular in view of muscular and nervous vessels relationship. Other factors to bear in mind are renal sequels and esthetic aspects.

Resumo: Introdução: a equinococose cística musculoesquelética é rara e pode determinar atrasos em seu diagnóstico e erros terapêuticos. Relato do caso: apresentamos o caso de uma paciente com cisto hidrático primário único ao nível da região femoral posterior direita, infectado. Discussão: foi realizada uma revisão nas bases de dados PubMed e LILACS sobre o diagnóstico e manejo terapêutico dos cistos hidráticos osteomusculares primários. Conclusões: a equinococose cística musculoesquelética deve ser considerada no diagnóstico diferencial de tumores de partes moles em pacientes de áreas endêmicas. A tomografia computadorizada e / ou a ressonância magnética desempenham um papel no planejamento diagnóstico e terapêutico. O tratamento é cirúrgico, adaptado ao paciente e ao cisto, dependendo de sua topografia, tamanho e, fundamentalmente, das relações vascular-nervosas e musculares. Outros fatores a serem considerados são as sequelas funcionais futuras e os resultados estéticos.

Hydatid cyst in the cervical spinal cord complicated by potentially life-threatening difficult airway: a case report / Cisto hidático na medula cervical complicada por via aérea difícil com potencial risco de vida: relato de caso

Abstract Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life-threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.

Resumo O cisto hidático na região cervical é uma condição extremamente rara que pode criar desafios para os anestesiologistas. O reconhecimento oportuno das vias aéreas difíceis e a preparação do plano de manejo são cruciais para evitar complicações com risco de vida, como danos cerebrais hipóxicos. Descrevemos um caso de difícil controle das vias aéreas em um paciente com cisto hidático cervical maciço. Utilizamos sedação com cetamina-propofol em baixa dose e spray de lidocaína para anestesia local orofaríngea. Relaxantes musculares não foram utilizados e a respiração espontânea foi mantida durante a intubação. O reconhecimento, a avaliação e o planejamento perioperatório são essenciais para o manejo difícil das vias aéreas em pacientes com cisto hidático cervical.

Unusual hydatid cysts: cardiac and pelvic-ilio femoral hydatid cyst case reports and literature review

Abstract Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

Our clinical experience and follow-up results in hydatid cyst cases: a review of 393 patients from a single center / Nossa experiência clínica e resultados no acompanhamento de casos de cisto hidático

Abstract Background and objectives: Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus. The aim of our study is to present the clinical features of the patients who were treated for hydatid cyst, determine the interventional techniques and anesthesia methods used and review the occurred complications in detail. Methods: This study included 393 patients who were followed up and/or treated with the diagnosis of hydatid cyst between January 2013 and November 2018. The patients' data was evaluated retrospectively. Results: The mean age of the patients was 31.0 ± 17.2 years. Of the patients, 111 (28.4%) had more than one cyst and 36 (9.2%) patients had multi-organ involvement. Six of the patients refused the intervention or was transferred to another hospital. Among the remaining 387 patients, 335 (85.2%) received general anesthesia and intubation, 9 patients (2.3%) received general anesthesia and laryngeal mask airway, 39 patients (9.9%) received sedoanalgesia and 4 patients (1%) received regional anesthesia. Perioperative mortality was developed in one patient. The most common periopertaive complication was allergic reaction (1.5%), whereas the most common post-operative complications were atelectasis (3.3%) and biliary fistula (3%). The mean Intensive Care Unit stay (ICU) was 1.9 ± 1.1 days in patients requiring ICU. Recurrence during the 40 ± 17 months follow-up occurred in 8.4% patients. Conclusions: Anesthesiologists have an important role in the management of hydatid cyst patients. Patients should be evaluated exhaustively in terms of multi-organ involvement and the presence of more than one cyst in the same organ. The type of treatment procedure and the localization of the cysts determine the anesthetic management.

Resumo Introdução e objetivos: Cisto hidático é uma zoonose causada por Echinococcus granulosus. O objetivo do estudo é apresentar as características clínicas dos pacientes submetidos a tratamento de cisto hidático, determinar as técnicas intervencionistas e os tipos de anestesia utilizados, e revisar as complicações ocorridas, em detalhe. Método: Este estudo incluiu 393 pacientes que foram acompanhados e/ou tratados com o diagnóstico de cisto hidático, entre janeiro de 2013 e novembro de 2018. Os dados dos pacientes foram avaliados retrospectivamente. Resultados: A idade média dos pacientes foi 31,0 ± 17,2 anos. Do total de pacientes, 111 (28,4%) tinham mais de um cisto, e 36 (9,2%) apresentavam comprometimento em vários órgãos. Seis pacientes recusaram a intervenção ou foram transferidos para outro hospital. Dentre os 387 pacientes remanescentes, 335 (85,2%) receberam anestesia geral e intubação, 9 (2,3%) anestesia geral e máscara laríngea, 39 (9,9%) sedação e analgesia, e 4 (1%) anestesia regional. Houve um óbito no período perioperatório. Reação alérgica foi a complicação perioperatória mais comum (1,5%), e no pós-operatório observou-se mais atelectasia (3,3%) e fístula biliar (3%). O tempo médio de internação na Unidade de Terapia Intensiva foi 1,9 ± 1,1 dias para aqueles que necessitaram desses cuidados. Recidiva durante o seguimento de 40 ± 17 meses ocorreu em 8,4% dos pacientes. Conclusões: Os anestesiologistas têm um papel importante no tratamento dos pacientes com cisto hidático. Os pacientes devem ser avaliados exaustivamente em relação a comprometimento de vários órgãos e presença de mais de um cisto no mesmo órgão. O tipo de procedimento terapêutico e a localização dos cistos determinam a conduta anestésica.

Quiste hidatídico en ventrículo derecho / Right ventricular hydatid cyst

A 20-year-old woman, without known pre-existent conditions presented with a history of dyspnea on exertion, and palpitations for 6 months. Vital signs, as well as cardiac and pulmonary examinations were normal. Routine blood tests were normal. The ECG showed nonspecific ST-T changes. The echocardiogram showed a left ventricle of normal size and function. A cystic image was shown in relation to the right ventricle, with displacement of the interventricular septum. These findings were confirmed on computed tomography. Additional cystic images on the liver or lungs were ruled out. On surgery, a cardiac hydatic cyst adhered to the pericardium next to the right ventricle was found. Puncture, drainage of the mass and surgical removal of cystic membranes were performed. The clinical course was uneventful. A four year follow up revealed no recurrence of the cyst.

Multiple Organ Echinococcosis:Report of One Case and Literature Review / 中国医学科学院学报

A patient with multiple-organ echinococcosis suffered from liver echinococcosis,lung echinococcosis,and pelvic echinococcosis successively in the past three decades.From the first operation at 19 years-old,she underwent operations several times due to the recurrence of multiple organ involvement.Echinococcosis is a zoonotic disease.Although the liver usually is the primary site,the disease can also invade many other organs.Diagnosis is typically based on disease history and imaging findings.Thorough removal of the lesions during the first operation is particularly important.Comprehensive evaluations and multi-disciplinary team are helpful in the treatment of patients with multiple organ invasion.

Hidatidosis cardíaca: tratamiento quirúrgico para recidiva de quiste hidatídico en ventrículo izquierdo / Cardiac hydatid disease: surgical treatment for recurrent hydatid cyst in the left ventricle

INTRODUCCIÓN: El quiste hidatídico cardiaco es una patología infrecuente, producida por la llegada de Equinococcus granulosus a la circulación coronaria. MATERIALES Y MÉTODO: Hombre de 52 años, con antecedente de quiste hidatídico cardiaco operado hace 27 años, insuficiencia cardiaca y enfermedad coronaria. Presentó disnea progresiva de un año de evolución. Estudio con radiografía de tórax, ecocardiografía y tomografía computada que mostró imagen compatible con hidatidosis cardiaca recidivada en el ventrículo izquierdo, arteria pulmonar e hilio pulmonar izquierdo, rodeando por completo el tronco coronario común izquierdo y parte proximal de la arteria descendente anterior. Se constató fracción de eyección de ventrículo izquierdo aproximadamente de 30%. No se encontró evidencia de enfermedad hidatídica extracardiaca. Se decidió tratamiento quirúrgico. Se abordó por esternotomía media y en circulación extracorpórea, se observaron lesiones compatibles con quiste hidatídico multiloculado de ubicación miocárdica en ventrículo izquierdo, con incontables vesículas hijas. Se realizó quistectomía más periquistectomía hidatídica sin incidentes. Presentó hemorragia postoperatoria por lo que requirió reintervención quirúrgica precoz. Evolucionó favorablemente y fue dado de alta sin complicaciones. A seis años de seguimiento se encuentra asintomático, sin evidencia tomográfica y ecocardiográfica de recidiva. DISCUSIÓN: La hidatidosis es una zoonosis endémica en Chile. La ubicación cardiaca es infrecuente, correspondiendo al 0,5 al 2% de los casos. Suele asociarse a la presencia de quistes extracardiacos. La ubicación más frecuente es la pared libre del ventrículo izquierdo a nivel intramiocárdico. El tratamiento médico suele ser insuficiente, por lo que se recomienda la resección quirúrgica.

INTRODUCTION: Cardiac hydatid cyst is a rare disease caused by Echinococcus granulosus arrival of the coronary circulation. MATERIAL AND METHOD: 52 years old man with a history of cardiac hydatid cyst operated 27 years ago, heart failure and coronary artery disease. He presented with a history of one year of progressive dyspnoea. Study with chest radiography, echocardiography and computed tomography showed an image compatible with cardiac hydatid disease recurrence in relation to the left ventricle, pulmonary artery and anterior descending artery. Ejection fraction of the left ventricle was approximately 30%. No evidence of extracardiac hydatid disease was found and surgical treatment was decided. Addressed by median sternotomy and extracorporeal circulation, a multiloculated myocardial hydatid cyst, with hundreds of daughter vesicles of different size was found. Pericystectomy of the hydatid cyst was performed without incident. The patient presented postoperative bleeding which required early reoperation. Posteriorly, was discharged without complications. DISCUSSION: Hydatid disease is an endemic zoonosis in Chile. Heart location is infrecuent and correspond to 0.5 to 2% of the cases, usually associated with the presence of extracardiac cysts. The most common location is the free wall of the left ventricle at intramyocardial level. Medical treatment is often inadequate and surgical resection is recommended.

Ruptura aguda de quiste hidatídico hepático hacia tórax / Acute rupture of a liver hydatid cyst into the thorax

El quiste hidatí­dico es una enfermedad parasitaria humana causada por el estado quí­stico del parasito Echinococcus granulosus. En el Perú hay zonas hiperendémicas de hidatidosis humana. Los quistes hidatí­dicos hepáticos son los más frecuentes, y la ruptura hacia el tórax es rara, siendo menor de 1% de los casos. Presentamos el caso de una paciente con quiste hidatí­dico hepático roto agudamente hacia tórax que es una patologí­a de difí­cil abordaje y de alto riesgo para el paciente y como fue resuelto en forma multidisciplinaria. (AU)

Hydatid cyst is a human parasitic disease caused by the cystic stage of Echinococcus granulosus. There are hyperendemic areas of hydatidosis in Peru. Liver involvement is the common affection of the disease, rupture of liver cysts into the thorax is rare (less than 1% of cases). We present the case of a female patients who presented with a liver cyst rupture to the thorax, a multidisciplinary approach was needed to cure the patient. (AU)

Intracoronary hydatid cyst resulted in coronary artery disease in a young patient

Abstract Among all cystic echinococcosis cases, only 0.5%-2% exhibit a cardiac involvement. Only 10% of these become symptomatic. Considering the long time interval between the start of infestation and symptoms to occur, it is hard to diagnose cystic echinococcosis. When detected, even if it is asymptomatic, intramyocardial hydatid cyst requires surgical intervention due to risks of spontaneous rupture and anaphylaxis. In literature, no case of hydatid cyst located in the coronary arterial wall has been reported. Twenty-two-year-old male patient with previous history of pulmonary cystic echinococcosis was referred to us with typical symptoms of coronary artery disease. Coronary cineangiography revealed proximal left diagonal artery (LAD) occlusion. Pre-operative transthoracic echocardiography of the patient planned to undergo coronary artery bypass grafting unveiled an intracoronary calcified cystic mass. In operation, the calcified cystic mass with well-defined borders and size of 2x2 cm located within wall of proximal segment of the LAD artery was excised and double bypass with left internal thoracic artery (LITA) and great saphenous vein grafts to the LAD and first diagonal arteries, respectively, was done. Pathological analysis of the mass revealed it to be an inactive calcified hydatid cyst. Echinococcal IgG-ELISA test was positive. 12-week oral albendazole treatment (2x400 mg/day) was launched postoperatively and the patient was discharged on 7th postoperative day.

Esplenectomía laparoscópica por quiste hidatídico primario de bazo / Laparoscopic splenectomy by primary hydatid cyst of the spleen

Objetivo: Describir el caso clínico de un paciente con quiste esplénico hidatídico de un año de evolución resuelto por vía laparoscópica. Materiales y Métodos: Mujer de 36 años con dolor en hipocondrio izquierdo por 1 año de evolución. El estudio topográfico objetivó lesión esplénica quística de 67 mm. Se realizó esplenectomía laparoscópica sin incidentes. Resultado: Evolución posoperatoria favorable. Histología compatible con hidatidosis esplénica. Discusión: La incidencia de hidatidosis esplénica es baja, incluso en áreas endémicas, aproximándose al 1-2%. La cirugía es la estrategia terapéutica de elección dado los riesgos de ruptura, sin embargo, no hay consenso respecto a la técnica de elección. Conclusión: La esplenectomía laparoscópica es una herramienta segura y avalada en la literatura.

Objective: Describe a case report of a hydatid splenic cyst of one year of evolution, treated by laparoscopy. Materials and Methods: A 36-year-old woman with left upper quadrant pain for 1 year. The topographic study showed a 67mm splenic cystic lesion. Laparoscopic splenectomy was performed without incident. Result: Favorable post-operative evolution. Histology compatible with splenic hydatidosis. Discussion: The incidence of splenic hydatidosis is low, even in endemic areas, approaching 1-2%. Surgery is the therapeutic strategy of choice, given the risks of rupture. However, there is no consensus regarding the technique. Conclusion: Laparoscopic splenectomy is a safe procedure supported by the literature.

Tumor primario quístico de la órbita: A propósito de un caso de hidatidosis infantil / Primary orbital cystic tumor: A case of hydatidosis in a child

RESUMEN Los tumores quísticos primarios de la órbita, causados por infestaciones parasitarias como el Equinococcus granulosus son raros. Al ser el Perú zona endémica para este parásito, presentamos el caso de una niña de 10 años de edad, proveniente de una zona rural de Huancavelica, con proptosis axial irreductible del globo ocular derecho, de curso progresivo, con pérdida de la agudeza visual e imágenes tomográficas de la órbita en relación a masa tumoral de apariencia quística. Los exámenes serológicos fueron negativos, la paciente fue sometida a resección quirúrgica con resultado histopatológico de membranas anhistas correspondientes a quiste hidatídico. Al año de seguimiento no se evidencia recurrencia local ni sistémica. En conclusión, ante una tumoración orbitaria quística en pacientes pediátricos, se debe de considerar como diagnóstico diferencial la hidatidosis orbitaria, sobre todo si proceden de zonas endémicas.

ABSTRACT Primary orbital cystic tumors caused by Echinococcus granulosus are rare. As this parasite is endemic in Peru, we report the case of a 10-year-old girl from a rural area of Huancavelica, who presented with progressive and irreducible axial proptosis of the right eye and loss of vision. Orbital tomographic images demonstrated a tumor mass with a cystic appearance. Serologic tests were negative. The patient underwent surgical resection, and histopathologic analysis revealed anhistic membranes, corresponding to hydatid cysts. During one year of follow-up, no evidence of local or systemic recurrence was observed. In conclusion, orbital hydatidosis should be considered in the differential diagnosis of a cystic orbital tumor in pediatric patients, especially if the patient is from an endemic area.

Primary pelvic hydatid cyst in a postmenopausal female: a surgical challenge

Primary pelvic hydatid cysts are a rare entity and are often overlooked as a differential diagnosis of a pelvic-space-occupying lesion particularly in non-endemic regions. Unpreparedness and a hasty decision on the surgical approach may end in life-threatening complications and systemic dissemination of the disease. We report the case of a 55-year-old postmenopausal woman with a history of two previous unsuccessful surgeries to remove pelvic cystic lesions due to dense adhesions between the surrounding gut wall, bladder, and the cyst wall. Clinical and imaging findings failed to diagnose the nature of the cysts, and a laparotomy was contemplated. On the third surgical attempt, the clinical suspicion was considered and by meticulous dissection the cysts were removed thoroughly without undue complications. In the postoperative follow-up period there was no sign of disease recurrence or dissemination.

Hidatidosis cerebral: comunicación de seis casos pediátricos / Cerebral hydatid disease: report of six pediatric cases

Hydatid disease is a parasitic infection whose etiologic agent is Echinococcus granulosus. Human is an accidental intermediate host and the most common site is the liver. The brain involvement is unusual and up to 75% of cases are described in the pediatric population. We present six children with cerebral hydatid disease admitted to the Pediatric Hospital J.P. Garrahan. All had neurological involvement on admission. The images showed single cystic lesion in the brain. They did not present involvement in other organs. Serology was negative in all cases. Medical and surgical treatment in all cases. The clinical outcome was favorable without sequelae in five of them and one had a residual paresis right faciobrachiocrural. This infection should be considered in the differential diagnosis of cystic tumor lesions of the central nervous system.

La hidatidosis es una infección parasitaria causada por Echinococcus granulosus. El ser humano es un hospedero intermediario accidental. La localización más frecuente es la hepática. El compromiso cerebral es inusual, se describe que hasta 75% ocurre en población pediátrica. Se presenta una serie de seis niños con hidatidosis cerebral internados en el Hospital de Pediatría J. P. Garrahan. Todos presentaron compromiso neurológico al ingreso. Las imágenes mostraron lesiones quísticas únicas en el cerebro. No tuvieron compromiso de otros órganos. La serología fue negativa en todos los casos. El tratamiento fue médico-quirúrgico. La evolución clínica fue favorable sin secuelas en cinco de ellos y uno presentó una hemiparesia faciobraquiocrural derecha como secuela. Esta infección debe considerarse entre los diagnósticos diferenciales de lesiones tumorales quísticas del sistema nervioso central.

A concomitant intramyocardial and pulmonary hydatid cyst: a rare case report

Abstract Cardiac hydatid cyst is an uncommon but potentially fatal disease. In cystic Echinococcus humans are an accidental host. Liver and lungs are the most frequently involved organs. Herein a unique case of intramyocardial hydatid cyst of left ventricle along with pulmonary hydatid cyst in a 38-year-old lady is reported. Surgical removal of the cardiac hydatid cyst was done with the aid of cardiopulmonary bypass followed by removal of pulmonary hydatid cyst.