Pp. 203–209 Hepatic hydatid cyst – diagnose and treatment algorithm

Figure 1: Hydatic cyst’s constitutive parts
Figure 2: Proligere membrane
plombage, drainage of the cavity by anastomosis with 
the stomach/jejunum, pericysto-biliar drainage. It should 
also be mentioned that hepatic transplantation might be a 
treatment option when at least 25-30% of the total hepatic 
parenchymal volume cannot be saved, or in the case of 
para- or post-hydatic hepatic cirrhosis [10]. The opening 
of the cystic cavity must be preceded by the inactivation of 
the parasite with a hypertonic saline solution, ethyl alcohol, 
hydrogen peroxide or Albendazole. It is also necessary to 
isolate the cyst from the rest of the peritoneal cavity, either 
by wrapping the adjacent areas with dressings soaked in 
anthelmintic substances or by applying adherent cones to 
the cyst using the icing technique or suction [11]. Resolving 
the remaining cavity is the primary challenge of the open 
surgical approach. In a study belonging to Mousavi et al., 
it is concluded that omental plumbing is superior to the 
drainage of the remaining cavity as it reduces the risk of 
seeding the peritoneum with germs [12].
Laparoscopic interventions are primarily suited for 
cysts located superficially on the anterior surface of the 
Table 1: WHO-IWGE classification of the hydatid cyst
Stage
Echographic aspect according to WHO-IWGE 
Classification
CL
Anechogenic uniloculated cyst, with no echoes or 
internal sepsis
CE 1
Anechogenic cyst, with fine echoes inside, 
representing the hydatic sand - active cyst
CE 2
Cyst with multiple septums at the interior, 
giving it a multivesicular aspect or “honeycomb” 
aspect,with a uniloculated primary cyst - active 
cyst
CE 3
Uniloculated cyst with decolated proligere 
membrane (“waterlily sign”) (CE3a) or daughter 
vesicles associating hypo/hyperechogene images 
(CE3b) - cyst in transition phase
CE 4
Cyst with mixed content, hypo/hyperechogenic, 
without daughter vesicles - “wool clew” aspect- 
cyst in the degenerative phase
CE 5
Cyst with partial or totally calcified wall - inactive 
cyst