Department and Clinic of Tropical and Parasitic Diseases, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland.
Department and Clinic of General and Transplant Surgery, Poznan University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland.
BMC Gastroenterol. 2020 Jun 5;20(1):176. doi: 10.1186/s12876-020-01320-0.
Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has world-wide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction.
We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it's further complications had not been observed before the operation.
Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it's results depends on the invasion period the patient is operated on. After the surgery the patient requires careful follow - up, to detect early complications.
感染细粒棘球绦虫会导致人类患上泡型包虫病。尽管这种感染分布广泛，但很少被发现。泡型包虫病的诊断较为困难，因为其临床表现不典型，影像学检查结果也不规律，提示肿瘤样病变始于肝组织或胆道。寄生虫的生长缓慢，因此，疾病在晚期入侵期往往才被确诊。长期、晚期诊断的感染治疗较为困难，需要寄生虫学家与外科医生合作，以避免危及生命的器官功能障碍。
我们描述了一名年轻男性患者，根据影像学、免疫学和组织学检查结果，诊断为细粒棘球蚴感染，接受了未行根治性切除病变组织联合持续服用阿苯达唑的治疗。进行了右半肝切除术。此外，还在非解剖性肝叶切除术中从左叶肝中切除了可见的囊肿，并切除了肝十二指肠韧带内可疑的钙化病变。术后发生门静脉高压症，伴有脾肿大和肝硬化症状（血小板减少、侧支静脉循环、一级食管静脉曲张）。门静脉高压可能是由于寄生虫感染广泛和手术引起的肝解剖结构改变导致手术不彻底所致，因为在手术前没有观察到门静脉高压及其进一步的并发症。
在肝脏不规则病变的鉴别诊断中应考虑细粒棘球蚴。长期感染可能导致不可逆转的继发性肝改变，如肝硬化和门静脉高压。手术治疗（首选治疗方法）较为困难，其结果取决于患者手术时的感染期。术后患者需要密切随访，以早期发现并发症。
