Diagnosis and surgical treatment of liver echinococcosis

The results of treatment of 72 patients with echinococcosis of the liver were analyzed, women – 62 (86.2%), men – 10 (13.8%). Primary echinococcosis was detected in 69 (95.8%) patients, secondary – in 3 (4.2%). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 63 (87.5%) patients, multiple – in 9 (12.5%). Among patients with solitary cysts, the right lobe was more often affected than the left – 48 (66.7%) vs 24 (33.3%) cases. Echinococcosis of central localization was less common and was noted in 8 (11.1%) cases. Echinococcosis complications were observed in 16 (22.2%) patients. Among them, most often there were suppurations of the cyst – in 13 (18.1%); a bursting of the cyst into the free abdominal cavity – in 1 (1.4%), in the pleural cavity – 1 (1.4%), in the biliary tract – in 1 (1.4%). Partial or complete liming of the hand was observed in 12 (16.7%) patients. In 20 (27.8%) cases, the operation was performed from the upper median access, in 42 (58.3%) – from oblique hypochondria accesses by Kocher or by Fedorov. Pericystectomy was performed in 48 (66.7%) patients, in 8 (11.1%) patients underwent resections of liver segments with an echinococcal cyst, in 4 (5.6%) – cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (16.7%) patients. In the postoperative period complications were observed in 16 (22.2%) patients. The use of the welding electrocoagulator EK-300M "Swarmed" in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from 2200±210 ml to 250±50 ml. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0.0001); duration of operation – 2 times (р<0.05), stay in hospital – 3.3 times (р=0.002). There were no fatal outcomes. Before and after operation antirelapse antiparasitic therapy with albendazole (Vormil) was performed in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was calculated at a rate of 15 mg/kg/day. There were 2 (2.8%) cases of relapse, there was no mortality.

Download Full-text

LIVER ECHINOCOCCOSIS: DIAGNOSIS AND SURGICAL TREATMENT EXPERIENCE

Kharkiv Surgical School ◽

10.37699/2308-7005.1.2021.12 ◽

2021 ◽

pp. 66-71

Author(s):

V. A. Shaprinsky ◽

O. O. Vorovsky ◽

О. О. Kamins’kyy ◽

A. V. Verba ◽

A. M. Formanchuk ◽

...

Keyword(s):

Blood Loss ◽

Abdominal Cavity ◽

Complete Recovery ◽

Diagnostic Value ◽

Liver Cysts ◽

Results Of Treatment ◽

Before And After ◽

Residual Cavity ◽

The Right ◽

Duration Of Operation

Summary. The purpose: to analyze the results of treatment of patients with liver echinococcosis. Materials and methods: results of treatment of 76 patients with echinococcosis of the liver were analyzed, women — 66 (86,8 %), men — 10 (13,2 %). Primary echinococcosis was detected in 73 (96,1 %) patients, secondary — in 3 (3,9 %). Among instrumental research methods, ultrasound and computed tomography examination were of diagnostic value. Single liver cysts were found in 66 (86,8 %) patients, multiple — in 10 (13,2 %). Among patients with solitary cysts, the right lobe was more often affected in 56 (73,7 %) patients than the left — 20 (26,3 %) cases. Echinococcosis complications were observed in 16 (21,1 %) patients. Among them, most often there were suppurations of the cyst — in 13 (17,1 %); a break of the cyst in the free abdominal cavity — in 1 (1,3 %), in the pleural cavity — 1 (1,3 %), in the biliary tract — in 1 (1,3 %). In 20 (26,3 %) cases, the operation was performed from the upper median access, in 46 (60,5%) — from oblique hypochondriac accesses by Kocher or by Fedorov. Pericystectomy was performed in 52 (68,4 %) patients, in 8 (10,5 %) patients had resections of liver segments with an echinococcal cyst, in 4 (5,3 %) — cyst opening with removal of contents and treatment of its cavity. Laparoscopic echinococectomy was used in 12 (15,8 %) patients. In the postoperative period, complications were observed in 16 (21,1 %) patients. The use of the welding electrocoagulator EK-300M «Swarmed» in the thermal rehabilitation of the walls of the residual cavity after echinococectomy allowed to reduce blood loss from (2200 ± 210) to (250 ± 50) ml, recurrences – with 2,8 up to 0 %. Before and after operation was performed antireсedive antiparasitic therapy with albendazole (Vormil) in two cycles of 28 days, separated by a 14-day break. The dose at body weight over 60 kg was 400 mg 2 times a day, and for less than 60 kg the drug was prescribed at a rate of 15 mg/kg/day. Results. With the use of laparoscopic echinococectomy, intraoperative blood loss was reduced by 9 times (р=0,0001); duration of operation — 2 times (р>0,05), stay in hospital - 3,3 times (р=0,002). There were no fatal outcomes. Conclusions. Pericystectomy is an effective operation for complete recovery and does not give recurrence of the disease. The use of a welding electrocoagulator and laparoscopic echinococectomy significantly improve the results of treatment of patients with parasitic liver cysts.

Download Full-text

Subhepatic caecum and appendix - a rare variant in an adult male cadaver

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401707 ◽

2013 ◽

Vol 02 (02) ◽

pp. 093-096

Author(s):

P. Savithri

Keyword(s):

Iliac Fossa ◽

Abdominal Cavity ◽

Intestinal Loop ◽

Diagnostic Challenge ◽

Inferior Surface ◽

Male Cadaver ◽

Hypochondriac Region ◽

Right Lobe ◽

The Right ◽

Symptoms And Signs

AbstractIn unusual cases of malrotation or incomplete rotation of caecum , the appendix is not located in the lower right quadrant. When the caecum is high [subhepatic caecum] the appendix is located in the right hypochondriac region and the pain in these cases is located there, not in the lower right quadrant. In this position , the symptoms and signs of acute appendicitis may mimic acute cholecystitis, diagnosis in such cases is a great diagnostic challenge. The author observed this less frequent anomaly in a middle aged male cadaver. After opening the abdomen while tracing peritoneal reflections abnormality was identified. The caecum and appendix were present in relation with inferior surface of liver. Embryologically, the caecal swelling appears as a small conical dilation of the caudal limb of primitive intestinal loop and it is the last part of the gut to reenter the abdominal cavity. It is temporarily located in the right upper quadrant directly below the right lobe of liver. From here it descends into the right iliac fossa. The failure to descend leads to subhepatic caecum.

Download Full-text

Ultrasonographic examination of liver and spleen of normal adult spiti horses and Himalayan Hill mules of India

Indian Journal of Animal Research ◽

10.18805/ijar.b-3409 ◽

2017 ◽

Author(s):

Uiase Bin Farooq ◽

Adarsh Kumar ◽

Rajni Chaudhary

Keyword(s):

Blood Vessels ◽

Abdominal Cavity ◽

Left Lobe ◽

Dynamic Parameters ◽

Liver Lobe ◽

Abdominal Ultrasonography ◽

Ultrasonographic Examination ◽

Splenic Parenchyma ◽

Right Lobe ◽

The Right

The main objective of this study was to develop baseline topographical data of landmarks for locating liver and spleen and to generate sonographic calliper measurements along with dynamic parameters of these organs. Abdominal ultrasonography was performed on 50 native adult (Spiti horses and Himalayan hill mules) healthy unsedated equines of either sex. The thickness, character and echo-architecture of liver and spleen were recorded. In horses, the right lobe of liver was found from 8th to 15th intercostal space (ICS) and left lobe from 6th to 11th (±1) ICS, while in mules the right liver lobe was found between 6th to 15th (±1) ICS and left lobe between 6th to 9th (±1) ICS. The liver was recognized by its branching vasculature and architecture was found relatively homogenous. In addition ventral edges were distinctly sharp. Spleen was found from 8th to 17th ICS both in horses as well as in mules. The splenic parenchyma was homogenously granular in appearance with few blood vessels and most echogenic organ in the abdominal cavity of equines. The only measurement that was reliably obtained was the central thickness or depth of the spleen, which varied from 41.4 to 68.4 mm (Mean± SE= 50.84±4.61 mm) in horses and 37.9 to 51.6 mm (Mean± SE = 42.76±2.34 mm) in mules. Therefore detailed ultrasonographic examination of liver and spleen helped us to compile baseline data, which will be helpful in management of the affections of liver and spleen in future.

Download Full-text

The Functional Relevance of Diffusion Tensor Imaging in Patients with Degenerative Cervical Myelopathy

Journal of Clinical Medicine ◽

10.3390/jcm9061828 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1828 ◽

Cited By ~ 1

Author(s):

Stefania d’Avanzo ◽

Marco Ciavarro ◽

Luigi Pavone ◽

Gabriele Pasqua ◽

Francesco Ricciardi ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Cervical Myelopathy ◽

Diffusion Tensor ◽

Diagnostic Value ◽

Hand Strength ◽

Predictive Tool ◽

Left Hand ◽

Before And After ◽

The Right ◽

Degenerative Cervical Myelopathy

(1) Background: In addition to conventional magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and predictive tool for patients with degenerative cervical myelopathy (DCM). In this preliminary study, we evaluated the use of quantitative DTI in the clinical practice as a possible measure to correlate with upper limbs function. (2) Methods: A total of 11 patients were enrolled in this prospective observational study. Fractional anisotropy (FA) values was extracted from DTI data before and after surgery using a GE Signa 1.5 T MRI scanner. The Nine-Hole Peg Test and a digital dynamometer were used to measure dexterity and hand strength, respectively. (3) Results: We found a significant increase of FA values after surgery, in particular below the most compressed level (p = 0.044) as well as an improvement in postoperative dexterity and hand strength. Postoperative FA values moderately correlate with hand dexterity (r = 0.4272, R2 = 0.0735, p = 0.19 for the right hand; r = 0.2087, R2 = 0.2265, p = 0.53 for the left hand). (4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM. Surgical decompression can improve the clinical outcome of these patients, especially in terms of the control of finger-hand coordination and dexterity.

Download Full-text

Giant solid mesenchymal hamartoma of the liver in a neonate: case report

Annals of Pediatric Surgery ◽

10.1186/s43159-020-00040-0 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Moaied A. Hassan

Keyword(s):

Histopathological Examination ◽

Abdominal Cavity ◽

Surgical Excision ◽

Abdominal Distension ◽

Mesenchymal Hamartoma ◽

Complete Excision ◽

Inferior Aspect ◽

Benign Liver Tumor ◽

Right Lobe ◽

The Right

Abstract Background Mesenchymal hamartoma is the second most common benign liver tumor in children, with 20% of the cases diagnosed during the neonatal period. The exact etiology in still unclear, and most investigators believe that it is a developmental anomaly rather than a true neoplasm. The presentation of these tumors is highly variable depending on the lesion’s size, ranging from small asymptomatic lesions to very large tumors with life threatening complications. Radical surgical excision, whenever possible, is the gold standard for treating these lesions to avoid the problems of local recurrence and possible malignant transformation. We present the rare occurrence of an entirely solid, giant hepatic mesenchymal hamartoma in a 3-week-old male newborn and discuss the mode of presentation, as well as the diagnostic and therapeutic approach. Case presentation A 3-week-old male newborn was referred to our institution with huge abdominal distension and respiratory distress. Imaging studies confirmed the presence of a very large solid intraabdominal mass occupying the majority of the abdominal cavity and abutting the inferior aspect of the right lobe of the liver, but did not reveal the diagnosis. At laparotomy, a huge solid mass was found attached to the right lobe of the liver. Complete excision was done, and histopathological examination confirmed the diagnosis of mesenchymal hamartoma. Conclusion Although rare, mesenchymal hamartoma of the liver can present as a neonatal surgical emergency. Emergency intervention is required in symptomatic patients. Radical surgical intervention is possible and is the treatment of choice to relieve the patient’s symptoms and avoid future complications.

Download Full-text

Results of the Controlled Clinical Test of Intraoperative Blood Reinfusion Hardware, Assembled From the Abdominal Cavity in Conditions of Slow and Fast Modes

Bulletin of Science and Practice ◽

10.33619/2414-2948/51/08 ◽

2020 ◽

Vol 6 (2) ◽

pp. 111-117

Author(s):

Sh. Abdurakhmanov ◽

Zh. Chyngysheva ◽

B. Musaliev ◽

E. Tilekov

Keyword(s):

Experimental Data ◽

Clinical Trials ◽

Blood Loss ◽

Abdominal Cavity ◽

Clinical Test ◽

Controlled Clinical Trials ◽

Experimental Control ◽

Clinical Control ◽

Before And After ◽

Comparative Description

Conducting parallel clinical and experimental control on the basis of controlled clinical trials was necessitated by, on the whole, a more thorough assessment of the effectiveness of intraoperative blood reinfusion hardware with the establishment of the possibility of ‘transfer’ of experimental data on modeling cavity blood loss to a clinical platform. Objective: a comparative description of the results of the following studies performed in the context of controlled clinical trials: 1) experimental control — a study of blood collected from the pleural and abdominal cavities before and after intraoperative blood reinfusion hardware under simulation conditions in animal injuries of the abdomen and chest with the formation, respectively, of hemothorax and hemoperitoneum; 2) clinical control — a study of blood collected from the abdominal and thoracic cavities before and after intraoperative blood reinfusion hardware in patients with injuries and injuries of the chest and abdomen with the corresponding formation of hemothorax and hemoperitoneum.

Download Full-text

Diagnostic program and tactical approaches to treatment of patients with obturative colonic obstruction of tumor genesis

Kazan medical journal ◽

10.17816/kmj1859 ◽

2012 ◽

Vol 93 (3) ◽

pp. 426-431

Author(s):

I S Malkov ◽

M M Toltoev

Keyword(s):

Bowel Obstruction ◽

Surgical Intervention ◽

Primary Anastomosis ◽

Colonic Obstruction ◽

Abdominal Cavity ◽

Digital Rectal Examination ◽

Postoperative Mortality ◽

Diagnostic Procedures ◽

Results Of Treatment ◽

The Right

Aim. To determine the value of ultrasound investigations, colonoscopy and laparoscopy in the complex diagnosis of acute obturative colonic obstruction of tumor genesis and in selecting the optimal treatment strategy. Methods. Conducted was an anlysis of results of treatment of 112 patients with obturative colonic obstruction of tumor genesis. A set of diagnostic procedures was carried out for every admitted patient: digital rectal examination, radiography of the abdomen, ultrasound examination, fiber colonoscopy, and laboratory studies. Results. Based on the clinical and radiographic the diagnosis of obturative colonic obstruction was established in 64.3%, ultrasound investigation revealed the presence of bowel obstruction without specifying its location in 92% of the cases. Emergency colonoscopy was informative only in 55.5% of cases due to inadequate prior preparation of the colon. Using the developed methodology of preparing the colon, it was possible to perform colonoscopy up to the level of the tumor in 26 patients (92.9%) out of 28 patients. In the 32 cases minimal surgical intervention were performed by way of formation of an ileotransverse anastomosis by-pass, double-barreled ileostomy or colostomy. 80 patients underwent resection of the bowel with the tumor, including operations with the formation of a primary anastomosis, which were performed in 20 patients when the tumor was located in the right segments of the colon. In 22 patients an intraoperative colonic lavage was performed. Postoperative complications were recorded in 30 (26.8%) patients. Postoperative mortality was 24.1% (27 patients). Conclusion. Based on the radiographic and ultrasound investigations of the abdominal cavity it is possible to establish the presence of bowel obstruction without specifying the localization of the obstruction zone; in order to determine the cause of the obturative colonic obstruction it is necessary to perform an emergency colonoscopy with rigorous preparation of the colon according to the developed technique, while the volume of surgical intervention should be determined in each case individually.

Download Full-text

Diagnostic Value of Open Biopsy for Malignant T-Cell Lymphoma of the Liver

International Surgery ◽

10.9738/cc162.1 ◽

2013 ◽

Vol 98 (1) ◽

pp. 13-18

Author(s):

Akihisa Hojo ◽

Hisashi Nakayama ◽

Osamu Aramaki ◽

Tokio Higaki ◽

Masamichi Moriguchi ◽

...

Keyword(s):

T Cell ◽

Cell Lymphoma ◽

Diagnostic Value ◽

T Cell Lymphoma ◽

Open Biopsy ◽

Abdominal Ultrasonography ◽

Abdominal Angiography ◽

Imaging Characteristics ◽

Right Lobe ◽

The Right

Abstract A 62-year-old man was referred to our hospital because of pain in the right upper quadrant. Laboratory tests revealed normal levels of tumor markers. Abdominal ultrasonography showed a hypoechoic mass of approximately 9 cm in diameter in the right lobe of the liver. Computed tomography revealed a low-density mass with peripheral enhancement in the posterior segment of the right lobe. Magnetic resonance imaging showed a low-intensity mass on T1-weighted images and a high-intensity mass on T2-weighted images. Abdominal angiography showed enhanced staining only at the periphery of the tumor. An open biopsy was performed and intraoperative examination of frozen sections indicated malignant lymphoma. The histopathologic diagnosis was malignant T-cell lymphoma. After combined chemotherapy, the tumor shrank to 4 cm in diameter. To our knowledge, only 15 cases of malignant T-cell lymphoma have been reported previously. Diagnosis is particularly challenging because this type of tumor has no distinctive imaging characteristics or signs or symptoms. This case emphasizes the need to include malignant T-cell lymphoma in the differential diagnosis and demonstrates the importance of open biopsy in patients with a suspected liver tumor.

Download Full-text

Analysis of surgical treatment of liver hemangiomas

Perm Medical Journal ◽

10.17816/pmj384129-141 ◽

2021 ◽

Vol 38 (4) ◽

pp. 129-141

Author(s):

I. N. Mugatarov ◽

M. F. Zarivchatsky ◽

V. A. Samartsev ◽

L. A. Bankovskaya ◽

E. D. Kamenskikh ◽

...

Keyword(s):

Surgical Treatment ◽

Outpatient Basis ◽

Surgical Interventions ◽

Results Of Treatment ◽

Abdominal Organs ◽

Right Lobe ◽

Perioperative Safety ◽

Surgical Tactics ◽

The Right ◽

Ct And Mri

Objective. Development of criteria for optimal tactics of surgical treatment of liver hemangiomas of various sizes and localizations. Materials and methods. A retrospective analysis of 247 patients with hepatic hemangiomas observed on an outpatient basis and in a hospital was carried out; 59 of them (23.89 %) were operated including 12 men and 47 women over the period of 19992019. Liver resection with hemangioma was performed in 30 patients, hemangioma enucleation in 21, X-ray endovascular occlusion in 8 patients. The diagnosis was established on the basis of ultrasound of the abdominal organs, CT and MRI with contrast as well as angiographic research methods. Results. The postoperative complications developed in 4 (6.78 %) cases: reactive pleurisy was detected in 2 patients after the right-sided hemihepatectomy, hematomas in the resection zone of segments of the right lobe of the liver with a tumor were diagnosed in 2 patients. All complications were eliminated by conservative measures. There were no lethal outcomes. Conclusions. Surgical treatment of patients with hemangiomas includes resection of the liver with a tumor, enucleation of the hemangioma, and various types of local destruction. In order to reduce the blood circulation of the tumor and decrease the risk of intraoperative blood loss, the ECA of the branches of the hepatic artery was indicated. A comparative analysis of the results of treatment of patients with liver hemangiomas using various methods of surgical interventions made it possible to develop optimal surgical tactics, a system of intra- and perioperative safety in this category of patients.

Download Full-text

Late presentation of congenital diaphragmatic hernia: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1510604r ◽

2015 ◽

Vol 143 (9-10) ◽

pp. 604-608 ◽

Cited By ~ 3

Author(s):

Sasa Radovic

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Clinical Manifestation ◽

Diaphragmatic Hernia ◽

Neonatal Period ◽

Abdominal Cavity ◽

Gastrointestinal Symptoms ◽

Inadequate Response ◽

Hernia Sac ◽

Right Lobe ◽

The Right

Introduction. Congenital diaphragmatic hernia (CDH) is a defect of the diaphragm with the penetration of organs of the abdominal cavity into thorax. Localization and size of the defect of the diaphragm condition the time and range of clinical manifestation. The most common is unilateral, without hernia sac, located on the left side, through posterolateral opening of the diaphragm and with clinical manifestation during the neonatal period. Smaller subgroup consists of patients with presentation outside the neonatal period with anatomic defect on the right side as is the case with our patient. Case Outline. Female infant aged seven months was hospitalized because of repeated episodes of shortness of breath and cough, with lack of progress in body weight. The discomforts had been present for the previous two months with an inadequate response to bronchodilator and antibiotic therapy used. After clinical, radiographic, ultrasound and computed tomography treatment, the right-sided diaphragmatic hernia was diagnosed, so surgical treatment followed. The defect of the diaphragm with hernia sac, through which the right lobe of the liver with visible line of entrapment, in the form of ?hourglass?, is pushed into thoracic cavity, was intraoperatively identified. The reposition of the right lobe of the liver in the abdominal cavity along with reconstruction of the diaphragm using interrupted mattress sutures was performed. Conclusion. The late manifestation of CDH should be suspected in cases of inexplicable acute or chronic respiratory or gastrointestinal symptoms with pathological radiography of the thorax. Accurate diagnosis and timely minimally invasive surgical intervention ensure an excellent prognosis.

Download Full-text