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

Table 2: Therapy protocol for hydatid cyst
Stage
Size
First-option treatment
Alternative treatment
Refusal of intervention or
contraindications for invasive treatment
ABZ (6 months)
CE1, CE3a
Small
Only ABZ (6 months)
PAIR + ABZ (1 month)
Medium
Surgical treatment + ABZ (1–6 months) PAIR + ABZ (month)
Large
Surgical treatment + ABZ (1–6 months) MoCaT + ABZ (1 month)
CE2, CE3b
Small
Only ABZ (6 months)
MoCaT + ABZ (1 month)
Medium
Surgical treatment + ABZ (1–6 months) MoCaT + ABZ (1 month)
Large
Surgical treatment + ABZ (1–6 months) MoCaT + ABZ (1 month)
CE4, CE5
Any diameter
“Watch-and-Wait” attitude
“Watch-and-Wait” attitude
Complicated cysts, no 
matter what stage
Any diameter
Surgical treatment (+/- interventional 
endoscopy in case of rupture into the 
biliary tract )+ ABZ (6 months)
Surgical treatment in case of rupture;
Percutaneous drainage in case of 
infection 
+ ABZ (1 month)

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Journal of Medicine and Life Vol. 11, Issue 3, July-September 2018
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inactive/calcified cysts, cysts that communicate with the 
biliary tree. The increased risk of secondary hydatidosis 
requires careful monitoring by postoperative serologic 
and imaging tests [15]. PAIRD (D=drainage) is a variant 
of PAIR that associates the insertion of an intracystic 
catheter at the end of the procedure. The cavity is irrigated 
with saline solution and drained for 24 hours. In case of 
cysts that communicate with the biliary tree, multivesicular 
cysts or cysts with content that cannot be suctioned, 
the PEVAC/MoCat (modified catheterization technique) 
can be used if the PAIR technique is not recommended. 
This technique involves inserting a 14F catheter into the 
cystic cavity, which will allow the evacuation of the solid 
content (daughter vesicles and endocyst) by successive 
injections and aspirations of an isotonic saline solution. 
The drainage tube is removed when the drainage is less 
than 10-15 ml/24 hours.