Hydatidosis and the duodenum: A systematic review of the literature

Table 1 Clinical data

Ref.	Sex	Age (yr)	Abdominal pain	Nausea and vomiting	Fever	Abdominal exploration	Past Medical history	Other signs and symptoms
Gilmas Y Mocoroa[16], 1963	Male	32	No	Yes (hematemesis)	38.5-39ºC	Six scars from previous surgeries. Slight collateral circulation. Soft splenomegaly with increased percussion. Epigastric pain on palpation	Dyspeptic vagal syndrome. Heartburn. Operated six times for hydatidosis	Melena. Daytime sleepiness and nocturnal delirium. Signs of hypoventilation and hypophonesis of right thorax
Perrotin et al[15], 1978	Male	37	Yes (RH)	Yes	38-39ºC	Guarding in the right hypochondrium. Right subcostal mass poorly limited and painful	NA
Cosme et al[13], 1987	Male	55	Yes (E)	NA	38ºC	Painful abdominal mass (12 cm × 15 cm) located in the epigastric region	Pleural effusion, recurrent episodes of bronchitis	Asthenia, anorexia and weight loss of 3 kg
Robbana et al[12], 1991	Female	64	NA	Yes (hematemesis)	No	Tender mass in right hypochon-drium	NA	Dysuria, diarrhea
Noguera et al[11], 1993	Female	60	Yes	NA	NA	Large tender epigastric mass	NA	Weakness, anorexia and joint pain
Thomas et al[14], 1993	Male	31	Yes	Yes (hydatidemesis)	39ºC	Ill-defined mass in the LH. Non-tender mass in the left iliac fossa. Smooth and firm hepatomegaly (6 cm). Rectal examination: Soft cystic swelling in the rectovesical pouch	Fully excised intraabdominal cysts at age 9 and 21 years	Hydatidenteria
Diez Valladares et al[9], 1998	Female	68	Yes (E)	Yes	NA	A tender mass in the epigastrium and right hypochon-drium	NA
Diez Valladares et al[9], 1998	Female	84	Yes	Yes	Yes	Tenderness and muscle guarding on the right side and a palpable mass	NA
Patankar et al[10], 1998	Male	35	Yes (RH)	No	No	Non-tender hepatomegaly	NA
Muinelo Lorenzo et al[8], 2012	Male	78	No	No	NA	NA	Osteoarthritis and benign prostatic hypertrophy. Laparoscopy cholecy-stectomy
Daldoul et al[4], 2013	Female	28	Yes (RH)	Yes	NA	Tenderness in right hypochon-drium and right lumbar fossa with lumbar contact	Liver hydatid surgery and recurrent hydatid cysts 21 and 17 years previously
Daldoul et al[4], 2013	Female	63	Yes (EH)	NA	38.6ºC	Abdominal involuntary guarding in the right hypochon-drium	NA	Anaphylactic reaction with diarrhea Chills and jaundice: Bilirubin: 10 mg/dl
Jarrar et al[7], 2015	Male	63	NA	Yes	NA	No palpable abdominal mass. Gastric distension	NA	Sensation of weight in RH
Akbulut et al[6], 2018	Female	46	No	Yes	No	Painful epigastric palpation	NA	Intra-abdominal aggressive fibromatosis

E: Epigastric; RH: Right hypochondrium; LH: Left hypochondrium; NA: Not available

Table 2 Analitical, radiological and endoscopic studies

Ref.	Leukocytosis	Red blood cell count	Hydatid serology	X-ray	Ultrasound	CT	Contrast studies	Endoscopy
Gilmas Y Mocoroa[16], 1963	16000 (84% neutrophils)	Erythrocytes: 3.286.000; Ht: 30% ESR: Katz Index 109	Casoni´s test: Positive	Chest: Right hemidia-phragm raised	NA	NA	Barium study: Stomach not filled due to huge cysts compressing the stomach body	NA
Perrotin et al[15], 1978	14300/µL	NA	Positive	Abdominal: No findings	NA	NA	Barium study: Heterogeneous opacity from the first portion of the duodenum, rounded cavity of 10 cm in the liver Cholangiography: Slightly dilated bile duct without signs of obstruction	NA
Cosme et al[13], 1987	12200/µL	Ht: 34%	NA	Abdominal: Supramesocolic mass of 15 cm deforming the stomach	Inconclusive	Cystic lesion with air-fluid level within the pancreas	Barium study: Fistula in the duodenum filling a pancreatic cyst with gas bubbles	Fistulous opening of 5 cm in diameter, in the duodenal bulb
Robbana et al[12], 1991	No	Hgb 11.1 g/dL	Positive	Abdominal: 10 cm right mass by L2-L3	14 cm cyst in right hypochon-drium	NA	X-ray with iodinated intravenous contrast: Right kidney delayed excretion and tumoral syndrome in lower lobe. Barium swallow test: Static stomach, megaduo-denum with fistulae to mass	Esophagitis type 1-2, chronic erosive gastritis. No access to duodenum
Noguera et al[11], 1993	NA	NA	NA	Chest and abdominal: Atypical gas bubble in the epigastric region with peripheral calcifications	NA	Cavity in the left hepatic lobe with partially calcified walls with communication with the duodenum. Another cystic multiloculated lesion in the peritoneal cavity lateral to the hepatic flexure of the colon	Iodinated oral contrast passing into the hepatic cavity confirmed the presence of a fistulous communication between the duodenal bulb and the cystic cavity	NA
Thomas et al[14], 1993	No	Hgb 11 g/dL	Casoni's test: Strongly positive	NA	Three cysts: Left and right hypochon-drium, pelvis	Multiple intra-abdominal hydatid cysts. One large cyst in the left hypochon-drium communicating with the stomach and the second part of the duodenum	NA	NA
Diez Valladares et al[9], 1998	No	Normal	Negative	Abdominal: Calcified circular line in the upper abdomen	NA	Calcified cystic mass in the left hepatic lobe and in continuity with the digestive tube	Barium swallow study: Cavitated mass communicating with the duodenum near the pylorus	Fistula in the pyloric region with features of an echinococcal cyst
Diez Valladares et al[9], 1998	18000/µL (85% neutrophils)	NA	NA	Abdominal: Calcified mass in right hypochon-drium	NA	Pneumoperitoneum and a liver cyst with an air fluid level	Barium swallow X-ray showed the presence of a cyst opening into de first duodenal knee	Cyst opening into duodenum
Patankar et al[10], 1998	NA	NA	NA	Chest: Crescentic gas shadow under the right dome of the diaphragm	NA	TC Dynamic contrast: Two cystic lesions in right liver lobe. Air in one of the cysts, tracking to the region of the first part of the duodenum. Another multiseptated cyst between urinary bladder and the rectum. CT oral contrast showed a megaduodenum and a fistula to the mass		NA
Muinelo Lorenzo et al[8], 2012	NA	NA	NA	NA	NA	3.5 cm hepatic hydatic cyst in segment IV	NA	Fistulous communication with calcified liver mass
Daldoul et al[4], 2013	11300/µL (18% eosinophils)	NA	NA	NA	NA	One multilocular hydatic cyst in the posterior part of the lateral sector of the right lobe of the liver, extended into retroperitoneum (until right kidney). Second hydatid cyst in segments I and V of the liver compressing the duodenum with a distended stomach	Barium swallow X-ray: Opacification of the hydatid cavity through a duodenal fistula near the pylorus. Preoperative cholangiogram: Retrograde opacification of the cyst through the duodenal fistula	NA
Daldoul et al[4], 2013	13700/µl (92% neutrophils)	NA	NA	NA	Two multivesicular hydatid cysts in segments IV and VI of the liver (5 and 6 cm respectively)	NA	NA	NA
Jarrar et al[7], 2015	NA	NA	NA	NA	NA	Upper gastrointestinal stenosis due to a hydatid cyst located in segment VI of the liver attached to the duodenum compressing it extrinsically	NA	Gastric stasis due to extrinsic compression of the second portion of the duodenum
Akbulut et al[6], 2018	NA	NA	Negative (postoperative)	NA	NA	CT scan with contrast 100 mm x 80 mm lesion originated by the body of pancreas		NA

CT: Computed tomography; NA: Not available; HT: Hematocryte; HGB: Hemoglobin

Table 3 Intraoperative findings, postoperative period and follow-up

Ref.	Intraoperative findings	Surgical procedure	Postoperative period morbidity	Follow-up
Gilmas Y Mocoroa[16], 1963	Multiple adherences from past surgeries. Stomach filled with blood clots. Multiple cysts (> 10) across peritoneum, liver, and spleen; duodenal fistula connecting with 15 cm cavity in left hepatic lobe	Ablation of cysts. Gastrostomy. Pylorotomy. Suture of duodenal fistula with surgical drains placed in cavity	Evisceration with massive hemorrhage. Postoperative death	NA
Perrotin et al[15], 1978	Adherences are found in the right hepatic lobe. Visualization of liver mass with purulent liquid and food remains. Intraoperative cholangiography: Communication of 1-1.5 cm diameter between the cyst and the duodenum	Fistula closed, cyst drained with a gastric aspiration probe and placement of a cholecystostomy	NA	Day 3: Probe is removed The drainage of the cavity after being washed with lactic acid is removed after 18 d. Control cholangiography and duodenal transit are normal. Follow up in clinics
Cosme et al[13], 1987	Infected and multivesicular hydatid cyst in the head of the pancreas closely attached to and communicating with the duodenum	Partial removal of the cyst with two catheters inserted into the cavity	NA	8th week: Injection of contrast through the drainage tubes demonstrating progressive closure of the remaining cavity. Asymptomatic 4 mo after surgery
Robbana et al[12], 1991	Calcified hydatid cyst in anterior kidney area. Fistula connected the kidney mass to the duodenum	Evacuation, intralaminar pericystectomy, and reduction of fistula. Vagotomy	NA	Discharged on 17th postoperative day. 7-mo postoperative ultrasound and urography were normal
Noguera et al[11], 1993	NA	Enucleation	NA	NA
Thomas et al[14], 1993	NA	Medical treatment: Albendazole, Ciprofloxacin, Crystalline penicillin and Chloroquine + US guided aspiration	NA	NA
Diez Valladares et al[9], 1998	Segment IV of the liver a 5 cm diameter mass adherent to the pylorus	Total resection of the cyst, including a piece of the duodenal wall, a Heinecke Mikulicz pyloroplasty, cholecystectomy and truncal bilateral vagotomy	Postoperative course was uneventful	Discharged on the 7th day
Diez Valladares et al[9], 1998	15 cm multiloculated hydatid cyst in right hepatic lobe in contact with the duodenum. Two hydatid cysts in the greater omentum with purulent fluid	Total cystectomy with resection of the duodenal sinus, excision of the omental cyst. Closure of the bile fistula and bile drainage	NA	Discharged on 15th day
Patankar et al[10], 1998	NA	Enucleation	NA	NA
Muinelo Lorenzo et al[8], 2012	NA	NA	NA	NA
Daldoul et al[4], 2013	Single multilobular hydatid cyst in the posterior part of the lateral sector of the right lobe in close contact with the duodenum. Duodenal fistula affecting the posterior wall of the duodenal knee	Cholecystectomy. Large resection of the prominent cystic dome. Duodenostomy associated with gastrostomy and jejunostomy to treat duodenal fistula	NA	After 6 wk the patient was discharged
Daldoul et al[4], 2013	Two liver cysts: Segment V (5 cm) and in the underside of the segment IV (8 cm) in close contact with the first duodenum knee. Exploration of the cystic cavity: Wide communication with the first duodenum and a large fistula with the confluence of the hepatic biliary ducts	Resection of the dome of the 5 cm cyst, duodenal diverticulization and external drainage	NA	Discharged after 3 wk
Jarrar et al[7], 2015	Multivesicular hydatid cyst measuring 6 cm, at the right lateral sector, with extraparenchymal development, adhering to the duodenum. Exo-vesiculation of 2 cm, communicating with the cyst, compressing the duodenal wall without fistula	Lagrot’s procedure, a partial cystectomy and epiploplasty filling the residual cavity	Postoperative course was uneventful	NA
Akbulut et al[6], 2018	The diameter of the fibromatous mass was 120 mm × 100 mm, originated in the pancreatic body and creating adherences to adjacent tissues forming a conglomerate with the fourth portion of the duodenum, jejunal loops and prepyloric stomach antrum	The fourth portion of the duodenum, the jejunum, the distal pancreas and the spleen were removed en bloc. Anastomosis between the third part of the duodenum and the proximal jejunum	Postoperative course was uneventful	NA

NA: Not available; US: Ultrasound.