Percutaneous drainage of hydatid cyst in the liver as a primary treatment: review of 52 consecutive cases with long-term follow-up.

AIM

To evaluate the suitability of percutaneous drainage as a primary and definitive treatment of hydatid disease of the liver.

MATERIALS AND METHODS

Between October 1989 and April 1992, percutaneous drainage was performed on 52 consecutive patients (27 women and 25 men aged 13 to 84 years) with 55 hydatid cysts in the liver. Twenty-five (45%) cysts were type I, 10 (18%) were type II, 14 (25%) were type III, 5 (10%) were type IV and 1 (2%) was type V. All procedures were performed under light sedation and local anaesthetic at the puncture site. The standard Seldinger technique was used. Initial puncture was performed under ultrasound (US) guidance through the liver parenchyma. The rest of the procedure was conducted under fluoroscopic control. Pigtail drainage catheters (size 12-20 Fr) were used, with Betadine (10% povidone iodine; 1% free iodine) being allowed to act within the cyst for 30 min, as a scolicidal agent.

RESULTS

All the patients were successfully treated and 6-9 year follow-up involving US, computed tomography (CT) and serology tests showed no local recurrence or spread of the disease. No major (death, cyst rupture, anaphylactic shock) and very few minor complications arose. Two patients had mild skin reaction with nausea requiring no treatment and three patients developed a secondary infection of the cyst, due to prolonged drainage time. These liver abscesses responded successfully to further catheter drainage. Subsequent patients were treated with large bore (18-20 Fr) catheters and none developed secondary infection. Overall drainage time varied from 7-118 days (7-28 days, if we exclude three initial cases who had prolonged drainage).

CONCLUSION

It is our strong belief that percutaneous drainage using the above method should be considered a first-line treatment for hydatid disease of the liver.Bosanac, Z. B., Lisanin, L. (2000). Clinical Radiology55, 839-848.