Albendazole as an adjuvant to the standard surgical management of hydatid cyst liver.

BACKGROUND: The treatment options for hydatid cyst liver include non-operative and operative methods. Operative methods include conservative and radical procedures. Non-operative methods include chemotherapy and percutaneous treatment of liver hydatidosis. MATERIAL AND METHODS: The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India, over a period of two years from March 2001 to February 2003 with further follow-up of 5-6 years. The study included 64 cases in the age group of 15 years to 64 years, comprising 36 males and 28 females. The aim of the study was to know the effect of preoperative and postoperative albendazole therapy on the viability of protoscolices and recurrence rate of hydatid disease of liver. Patients were divided into four group of 16 each. In group A, patients were directly subjected to surgery. In group B, patients were given albendazole for 8 weeks followed by surgery. In group C, patients were given albendazole for 8 weeks preoperatively followed by further postoperative course for 8 weeks. In group D, patients were first taken for surgery followed by postoperative course of albendazole for 8 weeks. RESULTS: Out of those patients who received preoperative albendazole only 9.37% had viable cysts at the time of surgery as compared to 96.87% of patients who did not receive any preoperative albendazole. In those patients who did not receive any albendazole therapy, recurrence rate was 18.75% whereas recurrence was 4.16% in patients who received albendazole therapy. CONCLUSION: We conclude that albendazole is safe and effective adjuvant therapy in the treatment of hydatid liver disease.

Biliary ascariasis as a cause of post-cholecystectomy syndrome in an endemic area.

BACKGROUND: Post-cholecystectomy syndrome encompasses numerous biliary, pancreatic and other entities. Biliary ascariasis is a common cause of adult biliary disease in an endemic area. Post-cholecystectomy biliary ascariasis, a cause of post- cholecystectomy syndrome although not yet defined is frequently seen in this part of the world. METHOD: Between Jan. 1990 and Jan. 2001, 104 cases of post-cholecystectomy biliary ascariasis were seen. Ultrasonography was found to be an excellent tool for diagnosing and monitoring of the worms inside the biliary tract. Endoscopic retrograde cholangiopancreatography had both diagnostic and therapeutic value. RESULTS: The majority (68.2%) of patients responded to conservative treatment. Surgical treatment was advocated in 18.2%, which included 2 patients with liver abscesses. Endoscopic extraction of worms was successful in 48.2%. CONCLUSION: Post-cholecystectomy biliary ascariasis as a cause of post-cholecystectomy syndrome needs to be included in the list of causes for post-cholecystectomy syndrome. Although the majority of patients respond to conservative treatment but endoscopic extraction or surgical intervention may be needed. Routine deworming of patients undergoing cholecystectomy both preoperatively and postoperatively should be done in all patients in endemic areas of ascariasis. Although this entity is rare in Europe and United States, due to population migration and increased travel, it is necessary for surgeons in these countries to be aware of this condition.

Surgical management of splenic hydatidosis.

PURPOSE: This study was conducted to evaluate the surgical management of splenic hydatidosis in an area where the disease is endemic. METHOD: Over a period of 16 years, 26 patients with splenic hydatidosis underwent surgery in our department. Preoperative investigations included plain abdominal X-ray, serology, ultrasonography, and computed tomography. RESULTS: In our series, splenic hydatidosis represented 3.5% of total abdominal hydatidosis. The majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. Twenty-two patients were operated on electively and 4 as emergency cases, including 2 with ruptured hydatids and 2 with infected hydatids of the spleen. Isolated splenic hydatid cysts were present in 21 patients, associated liver hydatid cysts in 4, and diffuse abdominal hydatidosis in 1 patient. All patients underwent splenectomy except for one patient who initially had partial splenectomy for a lower polar cyst. This patient also ended up undergoing a splenectomy for postoperative hemorrhage. One patient died on the sixth postoperative day (mortality rate 3.8%) as a result of multiorgan failure, and 4 developed minor complications (morbidity 15.4%). CONCLUSION: Splenic hydatidosis, although rare, is the third most common type of hydatidosis after liver and lung hydatidosis. This entity should thus be kept in mind when encountering a splenic cyst especially in areas where the disease is endemic. A splenectomy remains the treatment of choice because it demonstrates low morbidity and mortality rates.

Ascariasis-induced empyema of gallbladder: report of a case.

A rare case of a 52-year-old woman with empyema of the gallbladder due to ascariasis causing an obstruction in the cystic duct is presented. She was admitted on September 20, 2000, and on September 23 an emergency cholecystectomy was performed. Ultrasonography is a highly sensitive and specific method for diagnosing gallbladder ascariasis, and a cholecystectomy is considered mandatory for the treatment of empyema of the gallbladder.