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LIVER HYDATID CYST

LIVER HYDATID CYST. CLASSIFICATION OF HYDATID CYSTS. PRIMARY CYSTS MULTIVESICULAR OR SECONDARY CYSTS SECONDARY ABDOMINAL IMPLANTATION. Natural history of liver hydatid. 1 - Development of cyst – biliary communications 2 - Intrabiliary rupture 3 - Intraabdominal rupture

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LIVER HYDATID CYST

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  1. LIVER HYDATID CYST

  2. CLASSIFICATION OF HYDATID CYSTS • PRIMARY CYSTS • MULTIVESICULAR OR SECONDARY CYSTS • SECONDARY ABDOMINAL IMPLANTATION

  3. Natural history of liver hydatid • 1 - Development of cyst – biliary communications • 2 -Intrabiliary rupture • 3 - Intraabdominal rupture • 4 - Intrathoracic rupture • 5 - Intrathoracic rupture • 6 - Cyst death

  4. CLINICAL FEATURES • 1 – Symptomless • 2 –Painful or painless hepatomegaly • 3- Abdominal mass • 4-Jaundice • 5 - Intraperitoneal rupture

  5. DIAGNOSTIC STUDIES • Serological tests • Imaging techniques 1 Ultrasonography 2 CT scan 3 MRI 4 ERCP

  6. TREATMENT • Medical treatment bebzimidazole group Praziquantel

  7. Indications of medical treatment 1 Inoperable cases - Site - Multiple cysts 2 Concomitant diseases

  8. Contraindications 1 Pregnancy or lactation . 2 Heavily calcified cysts . 3 large cysts . 4 Obstructive jaundice .

  9. Surgical treatment • Objectives Remove all living cyst elements . Prevent spillage . Close biliary communications . Sterilize cavity .

  10. Scolicidal agents 1- Hypertonic saline ( 3 % ) . 2- Hydrogen peroxide 6% . 3- Citeramide . 4- Silver nitrate 0.5% . 5- Rectified spirit ( 96% ) . 6- Formalin

  11. Intrabiliary rupture • Operative cholangiogram . • Bile duct exploration . • T tube insertion . • Choledochoscopy .

  12. Residual cavity management • (1) Suture any obvious small bile duct openings • (2) Fill it with ordinary 0.9% saline • (3) Saucerize it by excising the protruding portion • (4) Fill it with a graft of omentum. • (5) Stitch the walls of the cyst

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