[Hydatid cust of the spigelian lobe of the liver: diagnosis and treatment]

ABSTRACT

Surgery of the hepatic of hygdated cysts is a current practical procedure in Marocco due to the endemic context it is generally simple, and the surgical technique is viell cadified. Nevertheless certain hepatic localization like segment I may engeder difficulties and operatory complications that the surgeon must know for a better management. This is a retrospective study over ten years, it concerns ten patients with hydatid cyst affecting the Spigelian lobe with or without other localization. There is a female predominance the mean age is 43 years. Four patients were already operated on for liver hydatid cyct two had involvement of caudal lobe. The clinical symptoms were not specific. Diagnostic imaging is mainly based on ultrasound and CT. All the patients were operated by laparotomy. Five patients had an hydatid cyst in caudal lobe only, four other associated hepatic lesions, and one case had a peritoneal hydatid disease. Type I was found in 2cases, type III in 5, type IV in one case and infected cyst in 2 cases. At surgical exploration it was found that caudael lobe cyst was intimatel anterioly with the hilum and the hepatic pedicle and with the inferior vena cava retrohepatic posterioly and at the right sue. We performed resection of the prominent dome ; the residual cavity was treated with hydrogen peroxide and systematically drained. The immediate postoperative were simple, the postoperative hospital stay was between 8 and 18 days. The surgical treatment of segment I hepatic hydatid cyst obyes the principals of hydated surgery and involues an important large vascular or buliarg wound risk. The resection of the prominent dome is an intervention simple, rapid and hemorrhagic with low mortality, but fails to eluminate a residual cavity may be ne seat of callection. Conservative treatment remains the gold standard, provided that there is a good postoperative monitoring and adequate management of biliary complications or infection