Percutaneous (skin) treatment in hepatic hydatid cyst

PERCUTANEOUS TREATMENT (EXTRACTION FROM THE SKIN) IN HYDATIC LIVER CYST

What is Hydatid Cyst Disease? It is one of the important parasitic diseases in our country. The parasite Echinococcus granulosus causes the disease. The eggs of the parasite are scattered around with the feces of animals such as dogs, cats, jackals, foxes and wolves that carry the parasite. Foods such as fruits and vegetables become contaminated with these eggs. The disease is transmitted to humans due to reasons such as eating contaminated food and not washing hands thoroughly after petting dogs with parasites.

In Which Organs Does Cyst Hydatid Disease Occur?Although it is most commonly seen in the liver and lung, disease can occur in the spleen, brain, muscle, bone and many other organs or tissues.

What are the Symptoms of the Disease? While the disease can cause varying symptoms depending on the organ in which it occurs and the size of the cyst, it is detected incidentally (on films such as ultrasound, computed tomography, etc.) in most patients without any symptoms. The situation is the same in hydatid cysts of the liver, and there may be symptoms such as jaundice in cysts associated with the biliary tract, and fever in cysts with inflammation.

Is the Disease Lethal? The disease can result in death. Anaphylactic reaction (sudden allergic reaction) that may develop as a result of the eruption of the cyst can lead to sudden death. Apart from this, important problems may arise with the pressure of the cyst on the surrounding structures.

How to Diagnose? The diagnosis of hepatic hydatid cyst cannot be made definitively with laboratory tests. The most important diagnostic tools are imaging methods such as Ultrasound (US), Computed Tomography (CT) and Magnetic Resonance (MR).

What is the Treatment of the Disease? Treatment of the disease with drugs (Mebendazole, Albendazole) alone is almost completely ineffective. The basic treatment method is Surgical (open surgery) or Percutaneous (extraction from the skin with a needle) treatments.

Which Cysts Should Be Treated? Although the number of the cyst and its location in the organ are important in determining the correct treatment to be applied in liver hydatid cysts, the most important factor is the internal structure of the cyst. Cyst classification is done with US and CT. There are 5 types of cyst according to the Gharbi classification. Among them, the most appropriate treatment method for Type 1 and Type 2 cysts is Percutaneous Treatment (excretion from the skin). One of the Percutaneous or Surgical treatments is applied to type 3 lesions by looking at the rate of fluid in them. That is, if the liquid content is more than the solid content in Type 3 cyst, percutaneous treatment can be applied. Type 4 lesions are mostly suitable for surgical treatment. Type 5 lesions are dead cysts and do not require any treatment. Apart from these, if the cyst is open to the biliary tract or is infected, the treatment is chosen regardless of the type. For example, if the Type 4 cyst is infected (inflamed), Percutaneous treatment can be performed. What are the Differences Between Surgical (Open Surgery) and Percutaneous (Closed Surgery) Treatment? In surgical treatment, mortality (death) is 6% and morbidity (undesirable negative effects) is around 12-80%. The recurrence rate of the disease after surgery is between 10-30%. The hospital stay in surgical treatment is 14-30 days. In percutaneous treatment, mortality is 0.1%, morbidity is 1-2% (in complicated lesions), and the recurrence rate is between 10-30%. In percutaneous treatment, the hospital stay is between 1-5 days. In short, it is much more advantageous than surgical treatment in patients who are suitable for Percutaneous Treatment (Extraction through the skin).

What is Percutaneous Treatment and How Is It Applied? Percutaneous treatment; It is the treatment performed by entering the cyst with a needle through the skin with the help of imaging devices such as Ultrasound, Computed Tomography or Fluoroscopy, or by placing a thin tube called a catheter. This procedure is done by an Interventional Radiology Specialist. The patient is processed with fasting for 6-8 hours. It is anesthetized by administering sleep-inducing and pain-relieving drugs intravenously. Then, a thin needle is inserted into the cyst. While some cysts are treated only through this needle, the majority of them are treated by placing a catheter (tube) through a series of procedures through this needle. After entering the cyst with a needle or tube, the cyst fluid is drained and the cyst is checked whether it is healthy or not by injecting a dyed drug into the cyst. Then, by administering hypertonic solution (20% NaCl) and 95% Alcohol, respectively, the living parasites in the cyst are killed. If placed, the catheter is attached to the skin with a few stitches. It is left to free drainage for a few days. In the following days, washings can be done through this catheter. Then the catheter is removed and the procedure is terminated.

What Is Done After Percutaneous Treatment? Albendazole treatment is started before percutaneous treatment is given to the patient and is continued after the treatment. First controls are made at the 1st, 3rd and 6th months after percutaneous treatment. Subsequent check-ups are sparse according to progress. Control is done with imaging methods such as US, CT and MR. If recurrence has occurred, percutaneous treatment is performed again.

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