A ten-year survey of hydatid disease (Echinococcus granulosus) in children.

During the period 1966-1976, 32 children from 6-16 years of age were admitted to the surgical service of Nemazee Hospital for hydatid disease. There were 16 males and 16 females. Eighteen patients had cysts of the liver, 13 had cysts of the lungs and 1 had a cyst of the orbit. Sixteen patients each had multiple cysts and 16 each had a single cyst. The location of multiple cysts were: liver in 10 patients, liver and kidney in 1, liver and cul-de-sac in 1, lungs in 3, lung and spine in 1 patient. Six patients had the disease in the right lobe of the liver, one in the left lobe and 11 had the disease in both lobes or the central part of the liver. There were 10 infected cysts: 7 in the lungs und 3 in the liver. Except for one recurrent cyst of the liver, all cysts were primaries. The incidence of hydatid disease in children compared to the incidence in the adult in the same period was 1 child to 12 adults (8.3%). The symptoms during the symptomatic period included abdominal mass, hepatomegaly, pain and jaundice in cysts of the liver; chest pain, cough and hemoptysis in cysts of the lung and chills and fever in both. Surgical management consisted of evacuation of the contents and resection of that part of the pericyst that was not covered by normal tissue. The pericyst was totally resected only when it was heavily fibrotic and resection was safely feasible, or when the pericyst was calcified. Two patients died, one following operation for hydatid cyst of the liver; the other died before the operation due to rupture of infected cyst of the lung into the bronchus and consequent respiratory arrest. Postoperative complications were prolonged bile drainage in two patients, in which both patients ceased their bile drainage spontaneously; one abdominal wound infection and one empyema occurred after operations for an infected cyst of the liver and an infected cyst of the lung respectively. The abdominal wound healed secondarily and empyema resolved after drainage. Enucleation of the endocyst or evacuation of the contents and parital excision of the pericyst were the safest management. The least-encountered complication of total excision was excessive blood loss.