Hydatid cysts of the spigelian lobe (segment I) of the liver: Clinical and therapeutic particularities

Objective > Hydatid cysts of the spigelion lobe, that is, segment I of the liver are rare. We analyzed their clinical and therapeutic particularities. Methods > We conducted a retrospective search for the hydatid cysts of the liver treated surgically in our deportment from January 1, 1994, through December 31, 2005. Cases were identified and confirmed with the following investigatory techniques: routine abdominal ultra-sonography abdominal computed tomography recommended by the ultrasound operator when a cyst was discovered in segment I, routine intraoperative cholangiography and three separate serological techniques: electrosyneresis, hemoglutination and ELISA (enzyme-linked-immunosorbent assay)(the latter two being quantitative). The cystic cavity was treated with hypertonic serum. Several surgeons performed different combinations of the following techniques: deroofing, sometimes with omentoplasty simple drainage, and subtotal pericystectomy. Results > We treated 44 hydotid cysts of segment I surgically in 10 men and 34 women, with a mean age of 40.6 years. Ten patients (22.7%) hod a history of hydatid cysts. Symptoms or complications were noted at admission in 45% of cases. only five cases (11.4%) required emergency surgery. Surgical examination confirmed vascular compression in 17 cases (38.6%) and a biliary fistula in 17 Cases (38.6%). Surgical treatment consisted of deroofing in 37 cases (84,1%), with omentoplasty in 23 (54%), subtotal peri-cystectomy In 3 and simple drainage in 4. Large biliary fistulas (> 5 mm) were treated with bipolar drainage in 2 cases and internal transfistulary drainage in 3. Some hemorrhaging occurred during surgery in 5 cases, and one cyst ruptured in the peritoneal cavity Albendazole was prescribed postoperatively for nine patients. There was one intraoperative death, secondary to hemorrhage resulting from erosion of the inferior vena cava. morbidity was 25%. After a mean follow-up of 32 months, five patients hod recurrences in the liver but outside segment I. Conclusion > Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications ore frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.