H. Tuğrul TİRYAKİ, Halil F. ATAYURT, Ziya LİVANELİOĞLU, Emrah ŞENEL, Fatih AKBIYIK, Ervin MAMBET

Karaciğer kist hidatik hastalıklı çocuk olgularda bilier sistem komplikasyonları daha mı az görülür

Amaç: Kist Hidatik (KH) hastalığı Echinococcus granulosus’a bağlı gelişen parazitik bir enfestasyondur. Olguların %50-70’inde karaciğer tutulumu olur. Karaciğer hidatik kistli olgularda en sık karşılaşılan komplikasyon, kistobilier ilişkinin olmasıdır. Çocuk karaciğer kist hidatikli olgularda, yüksek mortalite ve morbidite saptanan erişkin serileri ile karşılaştırıldığında, düşük komplikasyon oranları görülmektedir. Çalışmamızda karaciğer kist hidatikli çocuk olgularımızda saptadığımız komplikasyonlar değerlendirilerek literatürdeki erişkin serileri ile karşılaştırıldı. Metod: Karaciğer kist hidatikli 74 olgu geriye dönük olarak değerlendirildi. Hidatid kist tanısı tüm olgularda radyolojik incelemeler ile konuldu. Olgularımız ortalama 30 ay izlemde tutuldular. Bulgular: 2-15 yaş arasında (ortalama 9.5 yaş) 44 kız, 30 erkek olgu değerlendirmeye alındı. 74 olguda toplam 94 karaciğer hidatik kisti tedavi edildi. Serimizdeki olguların hiçbirinde ameliyat öncesi tıkanma sarılığı ve kolanjit bulguları saptanmadı. Üç olguda (%4) kist tekrarladı. Bir olguda (%1.3) uzamış safra drenajı ile karşılaşıldı. Dört olguda (% 5.4) 5 mm’nin altında safra yolu açıklığı gözlendi. Bir olgumuzda operasyon sırasında anaflaktik reaksiyon ile karşılaşıldı. Serimizde kaybedilen olgu olmadı. Sonuç: Erişkin serilerinin aksine komplike karaciğer kist hidatiği ile çocuk olgularda karşılaşmadık. Bu çalışmaya göre erişkinde karaciğer kist hidatiği hastalığı için belirlenen kist büyüklüğü, kistin lokalizasyonu gibi morbidite göstergeleri çocuk olgularda aynı şekilde morbiditeyi etkilemeyebilir. Bu nedenle çocuklarda özellikle bilier sisteme yönelik cerrahi girişimlerden kaçınılması vurgulanmak istenmiştir.

Is the billiary complication really seen lesser in children with hydatid liver disease

Background: Hydatid disease (HD) is a parasitic infection caused by Echinococcus granulosus. The liver is involved in 50-70 % of the cases. Cystobiliary communication is the most common complication of hepatic hydatid cysts. Low frequency of the complications of liver hydatid disease is noted in children when compared to adult series with high mortality and morbidity. We present our experience of complications in childhood liver hydatid cyst disease and compare the results with adult series. Methods: Seventy four cases of HD have been evaluated retrospectively. The diagnosis of HD was made on the basis of radiologic imaging methods. The median follow-up period was 30 months. Results: There were 44 females and 30 males, age ranging from 2 to 15 years (mean 9.5 years). Overall 94 liver hydatid cysts in 74 patients were treated. Obstructive jaundice and signs of cholangitis were not noted preoperatively in our series. Recurrence of cyst was seen in three patients (4%). Prolonged bilier drainage was seen in one patient (1.3%). Four patients (5.4 %) of our series had biliary opening up tosize of 5 mm . Anaphlactic reaction was seen in one patient intraoperatively. There were no mortalities. Conclusion: Unlike adult series we did not encountered complicated cyst hydatid disease in childhood. Predictors of morbidity for liver hydatid cyst in adults like age, size of the cyst, location of the cyst are not valid predictors in children. Therefore surgeons must be avoid of surgical procedure in children especially at biliary system.

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1. Sayek I, Yalin R, Sanaç Y. Surgical treatment of hydatid disease of the liver. Arch Surg 1980;11: 847-850.
2. Slim MS, Khayat G, Nasr AT, Jidejian YD. Hyadatid disease in childhood. J Pediatr Surg 1971;6:440-448.
3. Kalyoncu AF, Selçuk ZT, Emri AS, Cöplü L, Sahin AA, Bariş YI. Echinococcosis in the Middle East and Turkey. Rev Infect Dis 1991;13:1028-1029.
4. Tekin A, Kücükkartallar T, Kartal A, Kaynak A, Ozer S, Tavli S, Belviranli M, Sahin M, Yol S, Aksoy F, Tekin S, Vatansev C, Erikoglu M. Clinical and Surgical profile and follow-up of patients with liver hydatid cyst from an endemic region. J Gastrointestin Liver Dis 2008;17: 33-37.
5. Sayek I, Tirnaksiz MB, Dogan R. Cystic hydatid disease: current trends in diagnosis and management. Surg Today 2004;34:987–996
6. Tiryaki T, Şenel E , Akbıyık F, Mambet E, Livanelioğlu Z, Atayurt H. Kist Hidatik Hastalıklı Çocuklarda On Yıllık Deneyimimiz. Türkiye Çocuk Hastalıkları Dergisi 2008;2:19-25.
7. Harris KM, Morris DL, Tudor R, Toghill P, Hardcastle JD. Clinical and radiographic features of simple and hydatid cysts of the liver. Br J Surg 1986;73:835–838.
8. Akkiz H, Akinoglu A, Çolakoglu S, Demiryürek H, Yagmur O. Endoscopic management of biliary hydatid disease. Can J Surg 1996;39: 287-292.
9. Skroubis G, Vagianos C, Polydorou A, Tzoracoleftherakis E, Androulakis J. Significance of bile leaks complicating conservative surgery for liver hydatidosis. World J Surg 2002;26:704-708.
10. Köksal N, Müftüoglu T, Günerhan Y, Uzun MA, Kurt R. Management of intrabiliary ruptured hydatid disease of the liver. Hepatogastroenterology 2001;48:1094- 1096.
11. Daradkeh S, El-Muhtasab H, Falah G, Sroujieh AS, Abu-Khalaf M. Predictors of morbidity and mortality in the surgical management of hydatid cyst of the liver. Langenbecks Arch Surg 2007;392:35-39.
12. Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G. Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery: Are there significant preoperative clinical predictors ? Can J Surg 2006;49: 177-184.
13. Kayaalp C, Bostanci B, Yol S, Akoglu M. Distribution of hydatid cyst into liver with reference to cystobiliary communications and cavity-related complications.Am J Surg 2003;185:175-179.
14. Ozaslan E, Bayraktar Y. Endoscopic therapy in the management of hepatobiliary hydatid disease. J Clin Gastroenterol 2002;35:160-174.
15. Atli M, Kama NA, Yuksek YN, Doganay M, Gozalan U, Kologlu M, Daglar G. Intrabiliary rupture of a hepatic cyst: associated clinical factors and proper management. Arch Surg 2001;136:1249-1255.
16. Kayaalp C, Bzeizi K, Demirbag AE, Akoglu M. Biliary complications after hydatid liver surgery: incidence and risk factors. J Gastrointes Surg 2002;6:706-712.
17. Dadoukis J, Prousalidis J, Botsios D, Tzartinoglou E, Apostolidis S, Papadopoulos V, Aletras H. External biliary fistula. HPB Surg 1998;10:375-377.
18. Demirci S, Eraslan S, Anadol E, Bozatli L. Comparison of the results of different surgical techniques in the management of hydatid cysts of the liver. World J Surg 1989; 13:88-90
19. Dolay K, Akçakaya A, Soybir G, Cabioğlu N, Müslümanoğlu M, Iğci A, Topuzlu C. Endoscopic sphincterotomy in the management of postoperative biliary fistula. A complication of hepatic hydatid disease. Surg Endosc 2002;16; 985-988.
20. Demirbilek S, Sander S, Atayurt HF,Aydin G. Hydatid disease of the liver in childhood: the success of medical therapy and surgical alternatives. Pediatr Surg Int 2001;17:373-377.
21. Çelebi F, Balık AA, Salman AB, Oran D. Hydatid disease in childhood. Pediatr Surg Int 2002;18: 417-419.
22. Şenyüz OF, Celayir AC, Kılıç N, Celayir S, Sarimurat N, Erdoğan E, Yeker D. Hydatid disease of the liverin childhood. Pediatr Surg Int 1999;15: 217-220.
23. Alper A, Ariogul O, Emre A, Uras A, Otken A. Choledochoduodenostomy for intrabiliary rupture of hydatid cysts of liver. Br J Surg 1987;74:243-245.
24. Bedirli A, Sakrak O, Sozuer EM, Kerek M, Ince O . Surgical management of spontaneous intrabiliary rupture of hydatid liver cysts. Surg Today 2002;32:594-597.
25. Magistrelli P, Masetti R, Coppola R, Messia A, Nuzzo G, Picciocchi A. Surgical of hydatid disease of the liver. A 20-year experience. Arch Surg 1991; 126:518-523.
26. Yalin R, Aktan AÖ, Yegen C, Döşlüoğlu HH . Significance of intracystic pressure in abdominal hydatid disease. Br J Surg 1992;79:1182-1183.
27. Pedrosa I, Saiz A Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications Radiographics 2000; 20:795-817
28. Türkyılmaz Z, Sönmez K, Karabulut R, Demirogullari B, Göl H, Basaklar AC, Kale. Conservative surgery for treatment of hydatid cysts in children. World J Surg 2004; 28:597-601.
29. Dziri C, Paquet JC, Hay JM, Fingerhut A, Msika S, Zeitoun G, Sastre B, Khalfallah. Omentoplasty in the prevention of deep abdominal complications after surgery for hydatid disease of the liver: a multicenter, prospective, randomized trial. J Am Coll Surg 1999;188:281-289.
30. B Bozkurt, Saran A, Karabeyoğlu M, Unal B, Coşkun F, Cengiz O. Follow up and changes in obliteration of the residual cystic cavity after treatment for hydotidosis. J Hepatobiliary Pancreat Surg 2003;10:441-442.