Management of a liver hydatid cyst patient who fistulized the diaphragm and subsequently presented with thorax rupture: a case report.

Hydatid cysts, caused by Echinococcus species, are zoonotic diseases frequently observed in endemic regions worldwide, including Turkey. It is most commonly localized in the liver, followed by the lungs. Anaphylaxis and peritonitis, which develop after cyst rupture, are the most significant complications observed in these patients. Early diagnosis and prompt surgical intervention are extremely important. This study presented an extremely rare case of a hepatic hydatid cyst ruptured into the thorax, which may have high morbidity and mortality. A 24-year-old male patient presented to our emergency department with cough, dyspnea, fever, and allergy symptoms. He had a history of hepatic hydatid cyst surgery 5 years ago. Physical examination revealed urticarial lesions on the skin. The body temperature was 39 °C, and the pulse rate was 120 beats/min. Laboratory tests revealed leukocytosis and elevated C-reactive protein. Contrast-enhanced thoracic and abdominal computed tomography was performed. Diagnostic tests revealed that the patient had a ruptured hepatic hydatid cyst in the right thoracic cavity; hence, he was scheduled for emergency surgery. Laparotomy was performed via a right subcostal incision, and the ruptured cyst was located. It was understood that this cyst had fistulized into the diaphragm during a chronic process and subsequently ruptured acutely into the thorax. Partial cystectomy was performed for a ruptured liver cyst. The diaphragm was repaired, and catheters were placed in the thorax and abdomen for drainage. There were no other postoperative complications. Rupture of hydatid cyst disease is frequently observed in endemic regions. The rupture of a hepatic hydatid cyst into the thorax is an extremely rare event. In patients presenting with pulmonary symptoms who have a history of hepatic hydatid cyst surgery, the abdomen should always be thoroughly evaluated, and emergency surgery should be performed if required.

Endoscopic definitive treatment of liver hydatid cysts ruptured into bile duct.

BACKGROUND: Intrabiliary rupture (IBR) is one of the most common complications of hepatic hydatid cysts (HHC),and the surgical treatment of major intrabiliary rupture (MIBR) leads to serious morbidity and mortality. This study aimed to evaluate the efficacy of endoscopic definitive treatment of these patients. METHODS: This study included 38 patients who underwent ERCP for MIBR between 2004 and 2022. Endoscopic sphincterotomy (ES) was performed, followed by evacuation of hydatid contents from the main bile ducts and cyst cavity. A nasobiliary drainage (NBD) catheter was placed inside the cyst cavity in 15 patients, while biliary stenting (BS) was performed in 23 patients. Demographic data, cyst characteristics, hospital stay, complications, treatment success, and recurrence were analyzed. RESULTS: The mean age of patients was 46.5 years, with 12 female and 26 male. All patients had WHO-type-3B hydatid cysts with an average diameter of 7.9 cm. NBD was continued for definitive purposes in 13 of the 15 patients who underwent NBD, and full cure was achieved in 13 patients. Among the 23 patients who underwent biliary stenting (BS), 16 (69.5%) required a second ERCP due to jaundice or cholangitis, and 6 (26%) underwent percutaneous drainage due to hydatid cavity infection. The average length of hospital stay was 16.13 days in the BS group, while it was 8.3 days in the NBD group.The average follow-up period was 23 months. All patients achieved complete recovery. CONCLUSIONS: The endoscopic approach is an effective and safe method for the treatment of MIBR, and can be considered as a definitive treatment option in centers with adequate resources and experienced endoscopists.

Optimized Strategies for Managing Abdominal Hydatid Cysts and Their Complications.

Hepatic hydatid cysts are an example of a zoonosis with global distribution, but with endemic characteristics in certain geographic areas. Known since ancient times, this parasitic infection predominantly affecting the liver and lungs remains a challenge today in terms of diagnosis and the pharmacological, radiological, endoscopic, or surgical therapy. This study analyzed the complications associated with different procedures for treating hydatid cysts in 76 patients admitted to the County Clinical Emergency Hospital of Sibiu. Complications occurred in 18 patients (23.7%), with no significant correlation to age, gender, or residency (urban or rural). Patients undergoing open surgery exhibited the highest complication rate (61.1%) compared to those treated with other procedures. The most frequent complication was biliary duct rupture, occurring in 22.7% of cases. Our findings indicate that the presence of complications significantly prolongs hospitalization time [t df (75) = 12.14, p < 0.001]. Based on these findings, we conclude that the surgical approach for hydatid cysts should be meticulously tailored to each patient's specific circumstances to reduce the risk of complications and improve clinical outcomes.

Pituitary Apoplexy After a Major Abdominal Surgery: A Case Report.

Pituitary apoplexy is a major complication of pituitary adenoma, and the diagnosis might be challenging if the patient presents with signs of meningeal irritation or electrolyte imbalance. It can be fatal if not diagnosed and treated appropriately. Apoplexy is the first clinical presentation in the majority of pituitary adenoma cases. The pathophysiology of pituitary apoplexy involves bleeding and/or ischemia of pituitary enlargement. In this case report, we present a case of pituitary apoplexy that developed after a major abdominal surgery. The patient presented with headache, hypertension, and visual loss. After confirming the diagnosis through a CT scan, the patient underwent a transsphenoidal surgical decompression.

Liver Hydatid Cyst Masquerading as a Liver Abscess.

Hydatid cyst of the liver is a rare zoonotic disease in the United States. It is caused by Echinococcus granulosus. This disease is mainly seen among immigrants from countries where this parasite is endemic. Differential diagnoses of such lesions can include pyogenic or amebic abscesses, in addition to other benign or malignant lesions. We report the case of a 47-year-old woman who presented with symptoms of abdominal pain and was diagnosed with a hydatid cyst of the liver masquerading as a liver abscess. Microscopic and parasitological tests confirmed this diagnosis. The patient was treated and discharged without further complications during follow-up.

Hepatic hydatid cyst fistulized in the duodenum: Extremely rare complication.

The fistulization of a hepatic hydatid cyst to the duodenum is an extremely rare case demonstrated in computed tomography and confirmed surgically. We reported a case of 56 years-old woman representing this unusual complication. We show, through this work, the importance of radiological signs that can help to make the diagnosis before surgery.

Hepatic Hydatid Cyst With Cystobiliary Communication and Cystoduodenal Fistula.

The liver is the most common site affected by hydatid disease. Hepatic hydatid cyst (HHC) with cystoduodenal fistula is an unusual and infrequent complication. We present a 48-year-male diagnosed with an HHC with cystobiliary communication (CBC) and cystoduodenal fistula. The patient underwent partial cystectomy. Intraoperative demonstration of CBC was done with injection propofol, followed by primary closure of the CBC. The duodenal fistula was closed primarily with an omental patch, also known as a Graham patch. The patient improved well without any complications, and there was no recurrence of the symptoms for the subsequent five-month follow-up.

Feasibility of Laparoscopic Closed Cystectomy for Hepatic Hydatid Cyst in Segments VI, VII, and VIII.

Background Laparoscopic closed cystectomy of the hepatic hydatid cyst (HHC) is increasingly being performed as it has improved postoperative recovery and reduced morbidity. However, laparoscopic closed cystectomy of HHC is difficult when located in segments VI, VII, and VIII. This study aimed to assess the laparoscopic closed cystectomy feasibility of the HHC when cysts are located at the difficult access site. Methodology Seven patients out of 13 patients of HHC treated laparoscopically in the surgery department from 2014 to 2018 were included. These patients had cysts located in segments VI, VII, and VIII of the liver. All patients received perioperative albendazole, underwent ultrasonography (USG) and contrast-enhanced computed tomography for diagnosis. We noted the demographic character of all the patients, cyst's location, cyst size, type of the cyst, mean operative time, intraoperative and postoperative complications, duration of the hospital stay, and recurrence of the cyst.  Results All patients underwent laparoscopic closed cystectomy of HHC. One patient had a conversion to open procedure, and one patient had an additional thoracoscopic approach added. The mean operative time was 191.86 minutes. There were no intraoperative complications. One patient had developed a surgical site infection, and three had a minor bile leak postoperatively. The hospital stay's mean duration was four days, and there was no recurrence in the 21 months follow-up. Conclusion The laparoscopic closed cystectomy of HHC located at segments VI, VII, and VIII is feasible, safe, and cost-effective. A thorough preoperative evaluation, preparation, and radiological planning of the procedure should be done.

A Peculiar Case of Hydatid Disease.

Hydatid disease primarily affects the liver which is the most common location. This article highlights a rare representation of the hydatid disease which has led to hematogenous spread of the disease and gives us a wider picture that how a common disease can have an uncommon presentation. Another point that is addressed in this research article is that the widely accepted classification systems for hydatid disease can be modified even further, making them even more accurate. Here, we present a case of a 32-year-old male (non-smoker and non-alcoholic) who presented with focal neurological deficit, diffuse headache, diffuse abdominal pain, and breathing difficulties for the past six months. The patient is a known farmer and lives in an agricultural sheep-grazing area. With the help of MRI brain and non-contrast CT (NCCT) chest and abdomen, it was confirmed to be a case of multiple hepatic hydatid cysts in various stages, with transdiaphragmatic spread to adjacent lung and cerebral hydatidosis as evident by focal neurological deficit. No history of seizures has been given by the patient.

Manejo complicaciones biliares de la cirugía del quiste hidatídico hepático / Management of biliary complications of liver hydatid cyst surgery

Resumen La complicación más frecuente del quiste hidatídico hepático es la fístula biliar externa. El diagnóstico pre e intraoperatorio es esencial en el tratamiento. En dicha evaluación se describen factores predictivos que hacen sospechar las comunicaciones cistobiliares. En presencia de estas, es posible realizar estudios adicionales para su diagnóstico. La filtración y la fístula biliar son las complicaciones postoperatorias más frecuentes y las principales causas de morbimortalidad. Sus tasas pueden disminuirse siguiendo con acuciosidad los factores predictivos y el adecuado manejo de la fístula biliar postoperatoria.

The most frequent complication of hepatic hydatid cyst is the external biliary fistula. Pre and intraoperative diagnosis is essential in treatment. This evaluation describes predictive factors that make cystobiliary communications suspicious. In the presence of these it is possible to carry out additional studies for its diagnosis. Filtration and biliary fistula are the most frequent postoperative complications and the main causes of morbidity and mortality. Their rates can be decreased by acutely following the predictive factors and proper management of postoperative biliary fistula.

A case of Echinococcus granulosus hepatic hydatid cyst together with pyogenic liver abscess in a Nepali patient.

Hydatidic disease (echinococcosis) is a significant health problem in Nepal. In humans, mainly involves liver and commonly remains silent without symptoms or causing only mild pressure symptomatology. However, inadequate invasive medical procedures may cause the rupture of the cyst with serious complications, anaphylactic shock and death. Herein, we report the case of a Nepali patient who had been treated of a hepatic abscess with percutaneous drainage and antibiotics in a previous hospitalization. Study by drain fluid, ultrasonography and the magnetic resonance imaging revealed the presence of an intact Hydatidic cyst in the liver concomitantly with a percutaneously draining abscess (with free hooklets and a drain tube). This emphasizes the importance of putting the Hydatidic cyst into the differential diagnosis of liver abscess, especially in non-endemic areas.

Surgery for hepatic hidatidosis. Risk factors and variables associated with postoperative morbidity. Overview of the existing evidence. / Cirugía de la hidatidosis hepática. Factores de riesgo y variables asociadas al desarrollo de morbilidad postoperatoria. Revisión global de la evidencia existente.

There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis. A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS. 1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors. Risk and protective factors were identified; however, the studies are few and the quality moderate to low.

Hepatic Echinococcosis with Thoracic Involvement. Clinical Characteristics of a Prospective Series of Cases.

INTRODUCTION: Thoracic involvement (TIHE) is one of the evolutionary complications of hepatic echinococcosis (HE). AIM: The aim of this study was to describe the clinical characteristics and postoperative morbidity (POM) of a series of patients with TIHE treated surgically. MATERIAL AND METHODS: Series of cases of patients treated for TIHE between 2000 and 2014 in the Hospital Regional and Clínica Mayor in Temuco, Chile, with a minimum 12-month follow-up. The outcome variable was "development of POM". Descriptive statistics were used. RESULTS: The series was composed of 37 patients with a mean age of 53.2 ± 47.4 years (51.4% female). Mean cyst diameter was 19.4 ± 15.5 cm, and 75.7% of the lesions were located in the right hepatic lobe. The most frequent surgical technique used for the cyst was subtotal pericystectomy (56.8%); the residual cavity was treated by capitonnage (27.0%) or omentoplasty (21.6%), and a phrenoplasty with or without prosthetic material was performed for the TIHE. Mean hospital stay was 6.0 ± 5.7 days and follow-up was 61.4 ± 79.9 months; a mortality rate of 2.7% (one patient) and a POM of 24.3% (9 patients) were verified. CONCLUSION: TIHE is an uncommon evolutionary complication of HE associated with significant POM rate.

Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis

ABSTRACT Background. One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Material and method. Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. Results. A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. Conclusion. Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.(AU)

Early and late outcomes of surgery of non-complicated liver hydatid / Resultados precoces y tardíos de la cirugía de la hidatidosis hepática no complicada

Hepatic echinococcosis (HE) is a prevalent health problem, and there is limited published information regarding HE surgery. On the other hand, postoperative morbidity (POM) has not varied significantly. The aim of this study was to describe early and late outcomes in terms of POM of a series of patients with non-complicated liver hydatid cysts (NLHC) treated surgically. Prospective cohort. We included patients undergoing surgery for NLHC in the Hospital Regional and Clínica in Temuco, between 2000 and 2015. The main outcome variable was the development of early and late POM. Other variables of interest were hospital stay, mortality and recurrence. Surgical techniques used were total or subtotal pericystectomy and liver resection. Percentages, measures of central tendency and dispersion, and incidence were calculated. We studied 136 patients with a median age of 41 years and 60.3 % female The median ultrasound diameter of the cysts was 15.0 cm. The median surgical time was 95 minutes. The incidence of POM was 9.6 %, 92.3 % of whose cases were Grade I or II Dindo & Clavien. The aetiology was 5.9 % and 3.7 % medical complications of surgical complications. There was no mortality and with a median follow up of 115 months, recurrence was observed in one patient, representing an incidence of 0.7 %. POM was determined in a cohort of patients with NLHC throughout an extended follow-up period, and the incidence and gravity of POM is smaller and of lower gravity than those previously published.

Siendo una equinococosis hepática (EH) un problema de salud prevalente, la información publicada respecto a la cirugía de EH no es abundante. Por otro lado, la morbilidad postoperatoria (MPO) no ha variado de forma muy significativa. El objetivo de este estudio fue describir los resultados tempranos y tardíos en términos de MPO de una serie de pacientes con quistes hidatídicos hepáticos no complicados (QHHN) tratados quirúrgicamente. Estudio de cohorte prospectiva. Se incluyeron pacientes sometidos a cirugía para QHHN en el Hospital Regional y Clínica en Temuco, entre 2000 y 2015. La variable resultado principal fue desarrollo de MPO temprana y tardía. Otras variables de interés fueron estancia hospitalaria, mortalidad y recurrencia. Las técnicas quirúrgicas utilizadas fueron periquistectomía total o subtotal y resección hepática. Se calcularon porcentajes, medidas de tendencia central y dispersión, e incidencia. Se estudiaron 136 pacientes con una mediana de edad de 41 años; 60,3 % de los cuales son mujeres. La mediana del diámetro de los quistes y del tiempo quirúrgico fue de 15,0 cm y 95 min. Respectivamente. La incidencia de MPO fue 9,6 %, de los cuales 92,3 % fueron Grado I o II de Dindo y Clavien. La etiología fue: 5,9 % de complicaciones médicas y 3,7 % de complicaciones quirúrgicas. No hubo mortalidad; y con una mediana de seguimiento de 115 meses, se determinó una incidencia de recidiva de 0,7 % (1 paciente, en el período estudiado). Se describe la MPO de una cohorte de pacientes con QHHN. La morbilidad observada es inferior a la publicada y de bajo nivel de gravedad.

Intraperitoneal rupture of hydatid cysts.

PURPOSE: Hydatid cyst rupture into abdominal cavity is a rare but a serious complication. The rupture can occur after a trauma, or spontaneously as a result of increased intracystic pressure. It is a surgical emergency with high morbidity and mortality rates. Early diagnosis and appropriate surgical management of this complication can be life saving. The objective of the current paper is to evaluate the clinical, and radiographic findings and surgical treatment of this complication. METHODS: A retrospective study on 12 patients operated in our department for intraperitoneal rupture of hydatid cyst between January 1990 and May 2015. We reviewed age, gender, imaging findings, surgical treatment procedures, mortality, morbidity and recurrence. RESULTS: Our study includes 12 cases of intraperitoneal rupture of hydatid cysts; eight of the patients were men, and four were women. Four patients had a history of abdominal trauma and the other ruptures occurred spontaneously. All the patients had peritoneal irritation signs at presentation. All them underwent ultrasonography and CT scan. Imaging showed intraabdominal free fluid in all of cases. In 11 cases the cyst was unique and only in one case an associated mesenteric hydatid cyst was noted. Ruptured cysts were located in the right lobe of the liver in nine cases, in the left lobe in the other three cases. All the patients underwent emergency surgery after imaging. The procedure applied was conservative associated with drainage in all the cases. Some associated procedures were performed during the same operation. In only one case total pericystectomy for intraperitoneal cyst was performed. There were no post operative deaths. A total of five morbidities developed in three patients (one case of evisceration, three cases of biliary fistula and a case of pulmonary infection). CONCLUSIONS: Hydatid cyst rupture in peritoneal cavity is a rare complication. Imaging assessment has an important role in diagnosis but clinical signs are mandatory. A quick diagnosis and emergency surgery can decrease postoperative death. Surgery and postoperative care constitute the basis of treatment.

Surgical alternatives used in the treatment of liver hydatid cyst: a systematized approach based on evidence (an overview) / Alternativas quirúrgicas utilizadas en el tratamiento del quiste hidatídico hepático: revisión global de la evidencia

Echinococcosis is an endemic zoonosis in the south of Chile; we therefore have occasion to treat a large number of patients, particularly in the liver. Hepatic echinococcosis (HE) has its own morbidity and mortality due to evolutionary complications, to which the risk of complications related to the surgical procedures is added, the morbidity which has been reported up to 80 %. This is associated with a history of previous surgeries for HE, evolutionary complications of the cyst, the need for additional procedures such as the treatment of the disease in other simultaneous locations, etc. Moreover, reported mortality is up to 10 %, a situation that remains unchanged despite technological and therapeutic advances. The surgical treatment of HE can be divided into four phases: isolation of the surgical area, evacuation of the cyst, treatment of the complications of the cyst and treatment of the residual cavity. HE surgical procedures can be classified as conservative (marsupialization, cystostomy, Posadas technique and cystojejunostomy) and radical (pericystectomy and hepatic resections). Finally, the role of laparoscopic surgery, which is still under evaluation, is also worthy of note. The aim of this article is to present a general evidence-based overview of some surgical aspects of interest in the treatment of HE. In this article issues of the different surgical options utilized for HE treatment and their results are discussed, based on published evidence.

La equinococosis es una zoonosis endémica en el sur de Chile; por lo tanto, tenemos la oportunidad de tratar un gran número de pacientes, particularmente en el hígado. La equinococosis hepática (EH) tiene su propia morbilidad y mortalidad debido a complicaciones evolutivas, a lo que se añade el riesgo de complicaciones relacionadas con los procedimientos quirúrgicos. Se ha informado una morbilidad hasta del 80 %. Esto se asocia con antecedentes de cirugías previas para EH, complicaciones evolutivas del quiste, la necesidad de procedimientos adicionales, tales como el tratamiento de la enfermedad en otros lugares en forma simultánea, etc. Por otra parte, la mortalidad reportada alcanza el 10 %, una situación que se mantiene sin cambios a pesar de los avances tecnológicos y terapéuticos. El tratamiento quirúrgico de la EH se puede dividir en cuatro fases: aislamiento de la zona quirúrgica, evacuación del quiste, tratamiento de las complicaciones del quiste y tratamiento de la cavidad residual. Los procedimientos quirúrgicos de la EH se pueden clasificar en conservador (marsupialización, cistostomía, técnica y cistoyeyunostomía de Posadas) y radical (periquistectomía y resecciones hepáticas). Por último, el papel de la cirugía laparoscópica, que todavía está en proceso de evaluación, también es digno de mención. El objetivo de este artículo es presentar una visión general basada en la evidencia de algunos aspectos quirúrgicos de interés en el tratamiento de la EH. Se discuten los temas desde las diferentes opciones quirúrgicas utilizadas para el tratamiento de la EH y sus resultados, sobre la base de la evidencia publicada.

[Liver ultrasound: focal lesions and diffuse diseases]. / Ecografía hepática: lesiones focales y enfermedades difusas.

Liver ultrasound is frequently used as a first-line technique for the detection and characterization of the most common liver lesions, especially those incidentally found focal liver lesions, and for monitoring of chronic liver diseases. Ultrasound is not only used in the Bmode, but also with Doppler and, more recently, contrast-enhanced ultrasound. It is mainly used in the diagnosis of diffuse liver diseases, such as steatosis or cirrhosis. This article presents a practical approach for diagnosis workup, in which the different characteristics of the main focal liver lesions and diffuse liver diseases are reviewed.

Morbilidad postoperatoria en pacientes con hidatidosis hepática complicada / Post surgery morbidity in patients with complicated hepatic hydatidosis

Introduction: Hepatic echinococcosis (HE) surgery is common in southern's Chile hospitals; however, related publications are scarce and with conflicting results, especially with regard to postoperative morbidity (POM), due to the diversity in it severity. The aim of this study is to determine POM in patients undergoing surgery for complicated HE (CHE). Material and Methods: Case series part of a prospective cohort. Patients undergoing surgery for CHH in hospitals Hernán Henríquez Aravena hospital and Clínica Mayor of Temuco, between 2000 and 2012 were included. The main outcome variable was development of POM using the Clavien scale. Other variables of interest were hospital stay, mortality and recurrence. Descriptive statistics were applied and incidence of POM was determined. Results: 73 patients with a median age of 41 years and 58.9% female were studied. The median ultrasound diameter cysts were 15.0 cm. The average surgical time was 125.4 ± 26.3 min. The surgical procedure used most often was the pericystectomy (84.9%); and 84.9% of cases was performed concomitantly some other surgical procedure. The incidence of POM was 19.2%, 78.6% of whose cases were Grade I or II Clavien. The aetiology was 10.9% of medical complications and 8.2% of surgical complications. 1.4% of mortality was recorded; and with a median follow up of 97 months, no recurrence was verified. Conclusions: POM in a cohort of patients with CHE is lower than the published and low severity. Subgroups with higher POM were: patients with coexistence of more than one complication, those with colangiohydatidosis and patients with liver abscess of hydatid origin.

Introducción: La cirugía de la hidatidosis hepática (HH) es habitual en hospitales del sur de Chile; sin embargo, las publicaciones relacionadas son escasas y sus resultados disímiles, en especial respecto de la morbilidad postoperatoria (MPO), debido a la diversidad en la gravedad. El objetivo de este estudio es determinar la incidencia de MPO en pacientes intervenidos quirúrgicamente por HH complicada. Material y Método: Serie de casos, parte de una cohorte prospectiva. Se incluyeron pacientes intervenidos quirúrgicamente por HH complicada, en el hospital Hernán Henríquez Aravena y en la Clínica Mayor de Temuco, entre 2000 y 2012. La variable resultado principal fue desarrollo de MPO aplicando la escala de Clavien. Otras variables de interés fueron estancia hospitalaria, mortalidad y recurrencia. Se aplicó estadística descriptiva y, se determinó incidencia de MPO. Resultados: 73 pacientes, con mediana de edad de 41 años (16 a 84 años); 58,9% de género femenino. La mediana del diámetro ultrasonográfico de los quistes fue de 15,0 cm. El tiempo quirúrgico promedio fue de 125,4 ± 26,3 min. El procedimiento quirúrgico utilizado con mayor frecuencia fue periquistectomía (84,9%); y en 84,9% de los casos se realizó de forma concomitante algún otro procedimiento quirúrgico. La incidencia de MPO fue 19,2% (10,9% de tratamiento médico y 8,2% de tratamiento quirúrgico); 78,6% de cuyos casos eran Grado I o II de Clavien. Se registró 1,4% de mortalidad; y con una mediana de seguimiento de 97 meses, no se verificó recurrencia. Conclusiones: La incidencia de MPO en pacientes con HH complicada es inferior a la publicada y de bajo nivel de gravedad. Los subgrupos de complicaciones evolutivas con mayor MPO fueron la co-existencia de más de una complicación, la colangiohidatidosis y el absceso hepático de origen hidatídico.