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      Isolated Peritoneal, Mesenteric, and Omental Hydatid Cyst: A Clinicopathologic Narrative Review

      , MD

      Iranian Journal of Medical Sciences

      Iranian Journal of Medical Sciences

      Hydatid cyst, Peritoneum, Omentum, Mesentery, Echinococcosis

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          Abstract

          Hydatid disease (HD) is caused by Echinococcus granulosus and is endemic in many parts of the world. This parasitic tapeworm can produce cysts in almost every organ of the body, with the liver and lung being the most frequently targeted organs. Peritoneum, omentum, and mesentery are among these unusual locations, which can cause diagnostic challenge and treatment delay. This review provides information on the reported cases of the peritoneal, omental, and mesenteric hydatid cyst in the world during the last 20 years. During the last 20 years, there have been 49 published cases of hydatid cysts in the peritoneum, mesentery, and omentum. Among the reported cases in the English literature, the most common presenting symptom has been chronic abdominal pain and the method of primary diagnosis has been ELISA and ultrasonography. The best treatment modalities have been surgical excision, with and without adjuvant therapy, with albendazole and scolicidal agents. The published follow-up studies showed a low recurrence rate.

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          Hepatic Echinococcal Cysts: A Review

          Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with metacestodes (larval stage) of the Echinococcus granulosus tapeworm. E. granulosus are common parasites in certain parts of the world, and are present on every continent with the exception of Antarctica. As a result, a large number of people are affected by CE. The increased emigration of populations from endemic areas where prevalence rates are as high as 5–10% and the relatively quiescent clinical course of CE pose challenges for accurate and timely diagnoses. Upon infection with CE, cyst formation mainly occurs in the liver (70%). Diagnosis involves serum serologic testing for antibodies against hydatid antigens, but preferably with imaging by ultrasound or CT/MRI. Treatment methods include chemotherapy with benzimidazole carbamates and/or surgical approaches, including percutaneous aspiration injection and reaspiration. The success of these methods is influenced by the stage and location of hepatic cysts. However, CE can be clinically silent, and has a high risk for recurrence. It is important to consider the echinococcal parasite in the differential diagnosis of liver cystic lesions, especially in patients of foreign origin, and to perform appropriate long-term follow-ups. The aim of this review is to highlight the epidemiology, natural history, diagnostic methods, and treatment of liver disease caused by E. granulosus.
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            Unusual Locations of the Hydatid Cyst: A Review from Iran

            Hydatid disease is caused by Echinococcus granulosus and is endemic in many parts of the world, including Iran. This parasitic tapeworm can produce cysts in almost every organ of the body, with the liver and lung being the most frequently targeted organs. However, the cyst tends to appear in different and sometimes unusual body sites in various geographical areas of the world. This review provides information on the reported cases of the unusual body sites of the hydatid cyst from Iran in the last 20 years. A literature search was performed through PubMed, Scopus, Google Scholar, IranMedex, Society Information Display (SID), Magiran, and Irandoc using the keywords of “hydatid cyst and Iran” and “Echinococcus granulosus and Iran”, and 463 published cases of the hydatid cyst in unusual body sites from Iran were reviewed, evaluated, and discussed. The most common locations were the central nervous system (brain, spinal cord, and orbit), musculoskeletal system, heart, and kidney, while some less common locations were the spleen, pancreas, appendix, thyroid, salivary gland, adrenal gland, breast, and ovary.
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              Intra-abdominal extrahepatic echinococcosis.

              Twenty-seven patients who were treated surgically because of extrahepatic abdominal hydatid disease between 1981 and 1999 were retrospectively reviewed. Nineteen patients had coexistent hepatic cysts while 8 patients had only peritoneal cysts. The cysts were located in the spleen, pancreas, adrenal gland, mesentery of the intestines, ovaries, retroperitoneum, omentum, abdominal wall, rectovesical region, and the psoas muscle. Due to organ destruction because of large cysts in 8 patients, the involved organ had to be sacrificed. The other 19 patients were treated by a pericystectomy. No postoperative mortality or severe morbidity was seen. In conclusion, symptomatic or large cysts should be surgically treated. In cases suspected of having peritoneal spillage, antihelminthic drugs should be administered. In addition, small asymptomatic cysts may also be effectively treated with antihelminthics.
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                Author and article information

                Journal
                Iran J Med Sci
                Iran J Med Sci
                Iranian Journal of Medical Sciences
                Iranian Journal of Medical Sciences (Iran )
                0253-0716
                1735-3688
                November 2017
                : 42
                : 6
                : 517-523
                Affiliations
                Transplant Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
                Author notes
                Correspondence: Bita Geramizadeh, MD; Transplant Research Center, Department of Pathology, School of Medicine, Zand Blvd., Shiraz, Iran Tel\Fax: +98 71 36473438 Email: geramib@ 123456sums.ac.ir
                Article
                IJMS-42-517
                5684372
                Copyright: © Iranian Journal of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Review Article

                Medicine

                hydatid cyst, peritoneum, omentum, mesentery, echinococcosis

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