Brief Article
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World J Gastroenterol. Feb 7, 2011; 17(5): 646-650
Published online Feb 7, 2011. doi: 10.3748/wjg.v17.i5.646
Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts
Mohammed I Yasawy, Abdelrahman E Mohammed, Sammak Bassam, Mohammed A Karawi, Sohail Shariq
Mohammed I Yasawy, Department of Internal Medicine, Dammam University Hospital, Al-Khobar 31952, Saudi Arabia
Abdelrahman E Mohammed, Consultant Gastroenterologist, Riyadh Military Hospital, Riyadh 11159, Saudi Arabia
Sammak Bassam, Department of Radiology, Riyadh Military Hospital, Riyadh 11159, Saudi Arabia
Mohammed A Karawi, Department of Gastroenterology, Riyadh Military Hospital, Riyadh 11159, Saudi Arabia
Sohail Shariq, Department of Internal Medicine, King Fahd Military Medical Complex, Dhahran 31932, Saudi Arabia
Author contributions: Yasawy MI was in charge of adjuvant medical therapy and wrote the paper; Bassam S was the Senior Radiologist in charge of the radiological intervention; Mohammed AE and Karawi MA were consultants who offered and provided the cases; Shariq S was responsible for the literature search and collected the relevant references.
Correspondence to: Dr. Mohd I Yasawy, Consultant Internist/Gastroenterologist, Associate Professor, Department of Internal Medicine, Dammam University Hospital, PO Box 40143, Al-Khobar 31952, Saudi Arabia. yasawy@hotmail.com
Telephone: +966-3-8966741 Fax: +966-3-8966741
Received: July 23, 2010
Revised: November 11, 2010
Accepted: November 18, 2010
Published online: February 7, 2011
Abstract

AIM: To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration (PAIR) in the management of hepatic hydatidosis.

METHODS: Twenty-six patients with 32 hepatic hydatid cysts had PAIR. Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure. The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle, the cyst was punctured, cystic content (approximately 30 mL) was aspirated by a 12-14 F pigtail catheter and aspirated fluids were sent for analysis. Once the cyst was almost empty, two-thirds of the net amount of material aspirated was replaced by hypertonic saline and left in the cavity for about 30 min, with the catheter left in place for reaspiration of most of the fluid. When the amount of fluid drained was less than 10 mL per 24 h, the drainage catheter was removed.

RESULTS: All 32 cysts showed evidence of immediate collapse after completion of the procedure, and before discharge from hospital, ultrasound examination showed fluid reaccumulation in all cysts. Serial follow-up showed a progressive decrease in the size and change in the appearance of cysts. To confirm the sterility of these cystic cavities, seven cysts were reaspirated on average 3 mo after the procedure. Investigations revealed no viable scolices.

CONCLUSION: PAIR using hypertonic saline is very effective and safe with proper precautions.

Keywords: Percutaneous aspiration irrigation and reaspiration, Hepatic hydatid cyst, Adjuvant medical therapy, Treatment outcome