Colonic bilharzioma; surgical intervention versus conservative treatment

Bilharzioma implies a localized mass of fibrous and inflammatory tissue, which usually contains many eggs, frequently involving serosa and mesentery. Bilharzioma is probably caused by reaction to numerous eggs produced by one or more pair of worms in a single site. The aim of this study is to compare between surgical intervention and conservative treatment in a group of patients had colonic bilharzioma presented with abdominal masses and intestinal obstruction. Ten patients presented with abdominal masses and intestinal obstruction. Complete blood count, urine analysis and stool analysis done to all the patients of the study. Abdominal ultrasonogiaphy done in all the patients of the study. Abdominal computed tomography done in 6 patients. Barium enema done in 5 patients. All the patients of the study had been subjected to laparotomy. There were 7 males and 3 females, their ages ranged from 8 to 42 years [mean 14.2 years]. All the patients had abdominal pain [100%], 6 patients presented with abdominal mass [60%], and 4 patients presented with intestinal obstruction [40%]. There was microcytic hypachromic anemia in 9 patients [90%] and leukocytosis with eosinophilia in 7 patients [70%]. Abdominal US revealed presence of lymphoma versus teratoma in 6 patients [60%] and signs of intestinal obstruction in 4 patients [40%]. Barium enema revealed presence of multiple polyps throughout rectosigmoid colon, with loss of haustrations and spasm of descending colon in 3 cases. Colonic wall thickening with narrowing and rigidity of the ascending colon in 2 cases. Abdominal CT revealed presence of colonic wall masses suggestive of lymphoma in 6 cases. In laparotomy, there were 4 rectosigmoid bilharzioma, bilharzioma of the transverse colon down to the upper rectum in 3 patients and ascending colonic bilharzioma in 3 cases. Histopathology confirmed presence of bilharzial granuloma in all surgical specimens. Always consider bilharzioma in differential diagnosis of abdominal masses and intestinal obstruction, especially in countries where it is endemic.Biopsy is a must as clinical examination laboratory and radiological methods are not diagnostic

Surgical management of complicated hepatic hydatid cysts

Hydatid disease is a parasitic infestation caused by echinococcus granulosus characterized by cystic lesions in the liver, lungs, and rarely in other parts of the body. Yemen is highly endemic area for hydatid disease, especially in the northern areas with sheep-raising. Surgery is the cornerstone of management of hydatid cyst liver and aims to remove the cyst or its remnants and obliterate the residual cavity. The aim of this study is to identify the optimum and safest way for treating patients having complicated hydatid cyst liver with the least possible complications. This study includes characteristics on presentation, investigations, operative techniques, postoperative morbidity and mortality in a group of patients with complicated hydatid cyst liver. Twenty-two patients with complicated hydatid cyst liver were included in this study, ages ranged from four years to sixty-five years. These patients were managed over a period of 12 months, investigated by plain chest X-ray, abdominal ultrasonography and abdominal computerized tomography. Operative procedure was the rule, after correction of the general condition of the patients, where complete cystectomy was done in two patients, segmentectony was done in one patient, partial pericystectomy+capitonnage was done in three patients, partial pericystectomy+omentoplasty in nine patients and partial pericystectomy+external drainage in seven patients. Fourteen patients had a cyst on the right lobe, 6 patients ,had a cyst on the left lobe, and 2 patients had a cyst on both lobes. As regards surgical procedures, the patients were divided into 5 groups according to the type of operation; Group one consists of 2 patients with peripherally located small cysts. They underwent cystectomy. Group two consists of one patient underwent segmentectony, Group three consists of three patients underwent partial pericystectomy+capitonnage, group four consists of nine patients underwent partial pericystectomy+omentoplasty, Group five consists of seven patients underwent partial pericystectomy+external drainage, There is one postoperative death from postoperative hepatic failure. The principle of complete excision of the cyst, partial pericystectomy+capitonnage or omentoplasty or external drainage is applied in this study where complete cystectomy is the technique of choice in selected patients, as it is a associated with low morbidity and short hospital stay