Complications of the hydatid disease of the liver

Transcription

1 J. Nippon Med. Sch., Vol. 51, No. 1 (1984) (113)113 Note for Clinical Docrs Complications disease liver Xu Ming-qian Department Surgery, The People's General Hospital Xinjiang Uighur Aunomous Region Six hundred fifty patients disease liver had been treated by surgical operation in our hospital between , se 220 developed various complications (38.8%). In this paper, a preliminary analysis is presented forms manifestations. 1. Hydatid cyst infection One hundred twelve cases had cyst infection. The frequency developing cyst infection was higher in echinococcosis than in pulmonary echinococcosis, it was more ten encountered in adults than in children. Biliary fistula was leading cause infection, or facrs such as o numerous daughter, decreased cystic fluid, regressive cystic degeneration due malnutrition, o long a disease hisry, old feeble, reduced biologic activity, inflammary infiltration from adjacent areas blood-disseminated infection also causative this complication. Hepapostema was patient's first presenting sympm seen after cyst infection, followed by systematic inflammary responses, chilly feeling fever accompanied ten by jaundice,' xic anemia, wasting failure. The local signs significant : hepamagaly, persistent dull pain, tenderness knock pain might be found. 'Chronic consumption long period infection led wasting changes. A small proportion patients had no significant clinical inflammary 'responses probably owing hypertrophied wall ec restricted infiltration inflammation tissues. Roentgenoscopy showed raised diaphragm decreased movement diaphragm respiration ; in severe cases inflammary pleural effusion occurred disappearance cosphrenic cardiophrenic angles an obscure shadow between right lower chest liver area. 2. Hydatid cyst There 53 cases (8.10) cyst. The incidence was lower in echinococcosis than in pulmonary or or visceral echinococcosis, higher in children than in adults. The forcible pressure from outside might be leading cause, followed in turn by local shaking, perforation due infection Present address : Department Surgery, The People's General Hospital Xinjiang Uighur Aunomous Region, 91, Heaven Lake Road, Urumqi, Xinjiang, China

2 114(114) spontaneous (1). Twenty-four cases tract. The in liver tissues, extensive caused disrted be not free, thus on stained is products among became atrophic a sidual end loss duct due internal pressure, end, in opened Fig. 1 Huge residual loculus common bile residual loculus cyst connects larger fistula, in ablation right duct. lobe eccyst drainage common bile liver might be acute chole- ten accompanied secondary bacterial infection. on operation bile had leaked out from eccyst wall, principal cause infection in residual loculi (Fig. 1). Two cases cholecystistula study Obstructive fluid was gall in bladder necrotic long calculus seen leaving period cyst fragments daughter in it datid on surgical Cystic escaped form calculus Clay-like was deposited time. bile pigments necrotic in our cases. have, echinococcosis bile have become after found this or It was effusion this series cyst dudt. jaundice was seen in situation where tract was blocked by daughter endocyst fragments, ten producing acute obstructive pyogenic cholangitis. observed drainage duct. It shows occyst a provoking lodolography cyst, endocyst cystic fluid might flow duct, cystalgia chills fever, cyst following With liver. inner forming fistula. about re in presence pressure d disrtion shaken wall eccyst, brought residual duct wall duct, long-term endocyst wall eccyst or endocyst is membrane-like ductules proliferation because supporting liver cystic fluid remained impulse on it was seen Because develop as water. cholerrhagia, as clear tissues, growth liable operation yellow bile drain or minor surgical gave rise pressure be displaced effusion tract collapsed seen removal endoin (Fig. hy2). Fig. 2 Hydatid cyst in right lobe liver, complicated It demonstrates pigments, fragments. ger fistula, surgical multitude daughter removal calculus specimen. bile endocyst

3 (115)115 Cholangiography revealed chains small spherical defects in multitude duct was seen connect residual loculi eccyst by Tube T method. (2) abdominal cavity It was seen in 17 cases more frequent cystic fluid rapidly in children than in adults. escaped abdominal cavity, immediately causing After acute diffuse perinitis anaphylactic reaction. Of 17 cases, 9 had anaphylactic shock 1 had abrupt onset sharp abdomen pain anaphylactic shock owing pressure thigh on abdomen when bowing his trunk put on his boots while staying in hospital. He was immediately d, cystic fluid escaped perineal cavity. operated on, cyst was endocyst wash abdominal cavity repeatedly undertaken anaphylactic episode. patient's abdominal Measures found have clean tide patient over But six years later anor 13 removed from cavity. Three ec or cases liver permitted observed entrance in d entire endo perineal cavity, where adhesion endo epiploon, mesentery intestinal tract formed new ec wherein y resided. Suggestion was stimulated from this case removal intact endo be adopted in situation where project over surface liver. (3) lungs It occurred in 8 cases. The at p liver, resistance tissues, subjected grew upwards wards diaphragm gradually projected over surface liver; in addition, pressure chest was lower than abdominal cavity facilitated furr extension thoracic cavity ; when ec adhered diaphragm botm lungs following complicating secondary bacterial lungs followed penetration mary infiltration, abscess diaphragm resulting bronchial infection, owing by inflamin pulmonary fistula, daughter cyst fragments in purulent coughed In presence sputum staining yellow, it might be regarded duct- out. as a sign producing -bronchial fistula. Roentgenoscopy images pulmonary hilus pulmonis. cyst, re showed With appeared abscess sputum purulent inflammary drain gas entering an air-fluid mass for balance in Fig. 3 Hydatid cyst in right lobe liver, complicated lung bronchial fistula. It shows air-fluid balance in liver inflammary shadows lower field right lung.

4 116(116) liver, (4) Two liver are adhere, in absence thoracic fever, rapid thoracic effusion pulmonary (5) Two pressure, directly lower on fluid, float, a "soap at length, intra-abdominal floated thoracic cavity cases had thoracic lungs endocyst lots daughter breathing causing cavity. acute at pleural anaphylactic cavity developed When reaction. One shock. phragm, penetrated through infection pericardial extensive flammary ligaments bacterial sympms effusion p from botm chest pain, may two increase be d stifling chest, patients Roentgenography diaphragm, angle, On performing pericardiomy, adjacent inflammary liver It was observed botm inflammary infiltration pericardium, Roentgenoscopy cardiophrenic fluid daughter. d plugging. pericardial shadows at re 3). leads sudden effusion, anaphylactic detached If (Fig. high who showed had pleural atrophy. liver secondary trauma sign. be observed remains p pericardium cases developed pericardium. pulmonary "lotus-on-water" sign could Huge diaphragm, inflammation. cavity, showing bubble" disappearance acute position pericarditis fluctuation, complicating right mass diain- diaphragm. it was found pericardium was full purulent The pericardium was cleaned pulmonary lungs high it was huge following causing showed lung botm diaphragmatic penetrated tissues removed. sinus its Both patients cured ir disease by removal liver through diaphragm. (6) out abdominal It was seen in 1 patient who cyst at lower part liver, wall had pro- jected abdominal cavity adhered abdominal wall following infection. With long time inflammary infiltration, ration eccyst led perfo- cyst muscularis abdominal wall, forming abscess, gradually ulcerated drained f, leaving a collapsed endocyst. Having formed au- "marsupialization", patient recovered by free drainage 3. Anaphylactic (Fig. shock It occurred in 10 patients, cyst abdominal racic cavity, but 4). in none tract, 9 whom lungs, 1 tho34 cases pericardium, Fig. 4 Hydatid cyst in right lobe liver, complicated abdominal fistula.

5 (117)117 or abdominal wall. There 4 patients in this series who developed anaphylactic shock during operative phase. Clinical observations demonstratd anaphylactic shock appeared ten in presence contamination serous. cavity by cystic fluid tract or duct did not result in anaphylactic reaction.. 4. Disseminated implantation As a result cyst abdominal cavity, cystic fluid flows cavity, scolices swarming abdominal cavity. If not phagocytized by immunized cells, scolices adhere serous membrane abdominal viscera, develop new secondary (if scolices are ingested by dog, y develop Echinococcus granulosus in dog's intestine). Multiple may occur following ingesting many tapeworm eggs at a time. One case in this series had 27, as large as table tennis, it might be due infection at a time. Some patients echinococcosis developed abdominal several years later, might be derived from superinfection. Of 17 cases abdominal cavity, 14 had secondary abdominal echinococcosis. Four patients liver developed secondary abdominal after surgical operation. It was observed secondary disseminated caused by liver, as small as grains rice or as large as a fist, numbered from several hundreds, much like abdominal miliary tuberculosis. Adhesive intestinal obstruction complications such as infection generally encountered. Multiple surgical operations by areas involved by stages indicated over a period years. Because multitude large small, it was not easy clean m completely adjuvant treatment praziquantel was found be necessary for control. No secondary found in case liver lungs, might be due fact liver had been so infected as become purulent scolices had decayed could not regenerate; nor secondary seen in case tract. 5. Blood-disseminated implantation Two-three years after removal endo by puncturing in this series patients liver, 3 cases found have lung. Although it might be due superinfection, possibility existed scolices entered liver tissues n blood circulation, producing regeneration through blood-disseminated metastasis because pressure on liver on performing operation, contamination liver tissues by cystic fluid on incising ec on surface liver, liver damage caused by over force exerted on wiping out eccyst wall. 6. Jaundice Thirty-nine cases had increased icteric index. Jaundice usually appeared as

6 118(118) cyst infection infiltrated cells. Obstructive jaundice occurred in presence cyst duct or when tract was 'blocked by daughter or endocyst fragments. Of 24 cases tract seen in this series, 6 completely obstructive jaundice. Larger at site porta hepatis caused compression obstructive jaundice. After cyst duct, secondary acute pyogenic obstructive cholangitis was more ten observed, cholecystalgia, fever jaundice more prominent. After removal endocyst abjacent liver tissues began move wards cyst cavity owing collapsed eccyst, thus leaving duct be displaced disrted bile drain be not free. And inflammary infiltration residual loculus wall facilitated residual end duct, had become atrophique, residual loculi ec. Large amounts yellow slimy bile purulent exudate drained from residual loculi after operation generally lasted 1-3 weeks n gradually decreased. 7. Portal hypertension Twenty cases had portal hypertension. All had huge liver a long disease hisry. Clinical manifestations mainly enlarged' liver spleen, ascites varices abdominal wall. The author wishes extend his sincere thanks for advices critical veading manuscript Pr. Akiro Shirota, The First Department Surgery Pr. Hiroshi Shimizu, Department Radiology, Nippon Medical School. References 1) Xu, M.Q.: Hydatid disease. Xinjiang People's Press, Urumqi, ) Xu, M.Q.: Diagnosis treatment pulmonary echinococcosis. Chin. J. Surg., 6, 1358, ) Xu, M.Q. et al.: Diagnosis complications disease. Chin. J. Surg., 14, 88, ) Chen, W.Q. et al.: Diagnosis management disease liver. Chin. J. Surg., 17, 476, ) Xu, M.Q.: Roentgenodiagnosis disease. Chin. J. Radiol., 14, 95, ) Xu, M.Q.: Diagnosis treatment disease liver. Chin. J. Infect. Dis., 1, 83, ) Xu, M.Q.: Complications disease liver. J. Practical Surg., 3, 201, (Received for publication, January 6, 1984)