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Hydatid Cysts Follow-up

  • Author: Imad S Dandan, MD; Chief Editor: BS Anand, MD  more...
Updated: Aug 19, 2014

Further Outpatient Care

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  • Outpatient care is directed towards the following end points:
    • Chemotherapy: Postoperative treatment with benzimidazoles is continued for 1 month in patients with CE who have undergone complete resection or PAIR successfully. The treatment is continued for 3-6 months for patients with resected AE, incompletely resected CE, spillage during surgery or PAIR, and metastatic lesions. Chemotherapy is needed for 3-10 years for patients with partially resected AE, unresectable AE, or liver transplant for AE.
    • Laboratory tests: Patients on benzimidazoles should have a CBC count and liver enzyme evaluation performed at biweekly intervals for 3 months and then every 4 weeks to monitor for toxicity. ELISA or indirect hemagglutination tests are usually performed at 3-, 6-, 12-, and 24-month intervals as screening for recurrence of resected disease or aggravation of existing disease.
    • Imaging: Ultrasonography and/or CT scan are used in follow-up at the same intervals as the laboratory tests or as clinically indicated.

Further Inpatient Care

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  • Inpatient care for individuals who have had surgical resection of their hydatid cyst(s) is similar to that for any other surgical procedure on the affected organ.
  • Special consideration must be made for patients with hepatic CE who were found to have biliary communication. These patients must be observed for signs and symptoms of either biliary obstruction or fistula formation. If either of these complications occurs, the patient must be treated by percutaneous or endoscopic stenting of the biliary tree with or without sphincteroplasty.
  • Postoperatively, treatment with benzimidazoles is continued for approximately 1 month, although the exact duration has not been determined.

Inpatient & Outpatient Medications

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  • Antibiotics are used prophylactically for surgery as indicated in patients with a cystobiliary fistula, for treatment of infected cysts, and for treatment of associated infections.
  • Benzimidazoles are continued after discharge.


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  • Several criteria must be met in medical centers in order for patients to be treated appropriately. The lack of any of the following criteria should lead to patient transfer.
    • Medical staff experienced in the treatment of echinococcosis (eg, surgeons, radiologists, infectious disease consultants)
    • Medical centers that are able to provide the services for treatment (eg, well-equipped intensive care unit and surgical ward, well-equipped operating room, diagnostic radiology and laboratory facilities)
    • Availability of scolicidal agents


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  • Because human infection with Echinococcus results from fecal-oral contamination, prevention requires the following steps:
    • Education on proper hygiene
    • Proper cleansing of uncooked food and avoidance when possible
    • Dietary regulation of pet dogs (stop the habit of feeding viscera of intermediate hosts, such as sheep, to pet dogs)
    • Regulate pet dog activity to prevent ingestion of sheep material
    • Avoidance of unregulated dogs
    • Treatment of pet dogs in endemic areas for intestinal echinococcosis with praziquantel (5 mg/kg) periodically
    • Control of the dog population
    • Regulation of livestock butchering


See the list below:

  • All the usual complications related to the surgical procedure and anesthesia
  • Related to the parasite
    • Recurrence
    • Metastasis
    • Infection
    • Spillage and seeding (secondary echinococcosis) - Allergic reaction or anaphylactic shock
  • Related to the medical treatment
    • Hepatotoxicity
    • Anemia
    • Thrombocytopenia
    • Alopecia
    • Embryotoxicity
    • Teratogenicity
    • Spillage and seeding (secondary echinococcosis)
  • Related to PAIR
    • Hemorrhage
    • Mechanical damage to other tissue
    • Infections
    • Allergic reaction or anaphylactic shock
    • Persistence of daughter cysts
    • Sudden intracystic decompression leading to biliary fistulas
  • Related to scolicidal agents - Chemical sclerosing cholangitis


See the list below:

  • Prognosis mainly depends on the type of infestation (ie, whether it is CE or AE).
    • In CE, prognosis is generally good, and complete cure is possible with total surgical excision without spillage. Spillage occurs in 2-25% of cases (depends on location and surgeon's experience), and the operative mortality rate varies from 0.5-4% for the same reasons.
    • In AE, prognosis is much worse. Cure is only possible with early detection and complete surgical excision. In patients in whom the latter is not possible, the addition of long-term chemotherapy has decreased 10-year mortality rates from 94% to 10%.

Patient Education

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  • Education is aimed at teaching the population at risk about the disease, its methods of transmission, its hosts, and the methods of prevention (see Deterrence/Prevention).
Contributor Information and Disclosures

Imad S Dandan, MD Chief of Trauma Section, Scripps Memorial Hospital La Jolla, California

Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, California Medical Association, American Trauma Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.


Assaad M Soweid, MD, FACG, FASGE Associate Professor of Clinical Medicine, Endosonography and Advanced Therapeutic Endoscopy, Director, Endoscopy-Bronchoscopy Unit, Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Lebanon

Assaad M Soweid, MD, FACG, FASGE is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association

Disclosure: Nothing to disclose.

Firass Abiad, MD Fellow in Minimally Invasive Surgery, Department of Surgery, University of Tennessee

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Ann Ouyang, MBBS Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

  1. Wang K, Zhang X, Jin Z, Ma H, Teng Z, Wang L. Modelling and analysis of the transmission of echinococcosis with application to Xinjiang Uygur Autonomous Region of China. J Theor Biol. 2013 May 10. [Medline].

  2. Torgerson PR. The emergence of echinococcosis in central Asia. Parasitology. 2013 May 10. 1-7. [Medline].

  3. Moldovan R, Neghina AM, Calma CL, Marincu I, Neghina R. Human cystic echinococcosis in two south-western and central-western Romanian counties: A 7-year epidemiological and clinical overview. Acta Trop. 2012 Jan. 121(1):26-9. [Medline].

  4. Siracusano A, Delunardo F, Teggi A, Ortona E. Host-parasite relationship in cystic echinococcosis: an evolving story. Clin Dev Immunol. 2012. 2012:639362. [Medline]. [Full Text].

  5. Kapan S, Turhan AN, Kalayci MU, Alis H, Aygun E. Albendazole is not effective for primary treatment of hepatic hydatid cysts. J Gastrointest Surg. 2008 May. 12(5):867-71. [Medline].

  6. Ochieng'-Mitula PJ, Burt MD. The effects of ivermectin on the hydatid cyst of Echinococcus granulosus after direct injection at laparotomy. J Parasitol. 1996 Feb. 82(1):155-7. [Medline].

  7. Mamarajabov S, Kodera Y, Karimov S, Abdiev S, Sabirov B, Krotov N, et al. Surgical Alternatives for Hepatic Hydatid Disease. Hepatogastroenterology. 2011 Oct 12. 58(112):[Medline].

  8. Elsebaie SB, El-Sebae MM, Esmat ME, Nasr MM, Kamel MM. Modified endocystectomy versus pericystectomy in echinococcus granulosus liver cysts: a randomized controlled study, and the role of specific anti-hydatid IgG4 in detection of early recurrence. J Egypt Soc Parasitol. 2006 Dec. 36(3):993-1006. [Medline].

  9. Filippou D, Tselepis D, Filippou G, Papadopoulos V. Advances in liver echinococcosis: diagnosis and treatment. Clin Gastroenterol Hepatol. 2007 Feb. 5(2):152-9. [Medline].

  10. Flisser A. Larval cestodes. Collier L, Balows A, Sussman M, eds. Topley and Wilson's Microbiology and Microbial Infections. Parasitology. 9th ed. New York, NY: Oxford University Press; 1998. Vol 5: 539-60.

  11. Gargouri M, Ben Amor N, Ben Chehida F, Hammou A, Gharbi HA, Ben Cheikh M, et al. Percutaneous treatment of hydatid cysts (Echinococcus granulosus). Cardiovasc Intervent Radiol. 1990 Jun-Jul. 13(3):169-73. [Medline].

  12. Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ. 1996. 74(3):231-42. [Medline]. [Full Text].

  13. Heath DD. Immunology of echinococcus infections. Thompson R, Lymbery AJ, eds. Echinococcus and Hydatid Disease. Wallingford, Oxon: CAB International; 1995. 183-200.

  14. Kjossev KT, Losanoff JE. Hydatid cysts of the liver: TN(R)C classification. Int Surg. 1998 Oct-Dec. 83(4):311-3. [Medline].

  15. Liu D, Lightowlers MW, Rickard MD. Evaluation of a monoclonal antibody-based competition ELISA for the diagnosis of human hydatidosis. Parasitology. 1992 Apr. 104 ( Pt 2):357-61. [Medline].

  16. Liu YH, Wang XG, Chen YT, Yao YQ. Computer tomography of liver in alveolar echinococcosis treated with albendazole. Trans R Soc Trop Med Hyg. 1993 May-Jun. 87(3):319-21. [Medline].

  17. Polo JR, Garcia-Sabrido JL. Sclerosing cholangitis associated with hydatid liver disease. Arch Surg. 1989 May. 124(5):637. [Medline].

  18. Schröder R, Robotti G. New aspects in the management of alveolar echinococcosis involving the liver. World J Surg. 1986 Dec. 10(6):968-73. [Medline].

  19. Tan A, Yakut M, Kaymakçioglu N, Ozerhan IH, Cetiner S, Akdeniz A. The results of surgical treatment and percutaneous drainage of hepatic hydatid disease. Int Surg. 1998 Oct-Dec. 83(4):314-6. [Medline].

  20. Taylor BR, Langer B. Current surgical management of hepatic cyst disease. Adv Surg. 1997. 31:127-48. [Medline].

  21. Taylor DH, Morris DL. In vitro culture of Echinococcus multilocularis: protoscolicidal action of praziquantel and albendazole sulphoxide. Trans R Soc Trop Med Hyg. 1988. 82(2):265-7. [Medline].

  22. Todorov T, Mechkov G, Vutova K, Georgiev P, Lazarova I, Tonchev Z, et al. Factors influencing the response to chemotherapy in human cystic echinococcosis. Bull World Health Organ. 1992. 70(3):347-58. [Medline].

  23. von Sinner WN. New diagnostic signs in hydatid disease; radiography, ultrasound, CT and MRI correlated to pathology. Eur J Radiol. 1991 Mar-Apr. 12(2):150-9. [Medline].

  24. Williams JF, Perez Esandi MV, Oriol R. Evaluation of purified lipoprotein antigens of Echinococcus granulosus in the immunodiagnosis of human infection. Am J Trop Med Hyg. 1971 Jul. 20(4):575-9. [Medline].

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