Hepatic Hydatid Cysts in Children: Clinical Presentation, Treatment Modalities, and LongTerm Outcomes

¹Mumtaz Ahmed Qureshi, ²Imtiaz Ahmed Qureshi, ³Dr. Roshan Ali Siyal, ⁴Dr. Iqra Aslam

¹Assistant Professor, Department of Pediatric Surgery, MBBS, FCPS, FACS (USA), Liaquat
University of Medical & Health Sciences, Jamshoro
²Assistant Professor, Department of Pediatric Surgery (MBBS, MS), Liaquat University of Medical &
Health Sciences, Jamshoro
³Assistant Professor, Department of Pediatric Surgery (MBBS, FCPS), Liaquat University of Medical
& Health Sciences, Jamshoro
⁴Consultant Pediatric Surgeon, Department of Pediatric Surgery (MBBS, FCPS), Liaquat University
of Medical & Health Sciences, Jamshoro
Abstract:
Background:
Cystic echinococcosis is a well-known public health issue in the endemic regions of Asia, including
Pakistan. The liver is one of the most frequent target organs among children, but there is limited
information in the literature regarding the management of hepatic hydatid cysts in pediatric patients.
To describe the presentation, diagnosis, and management options along with their outcomes in
pediatric patients with hepatic hydatid cysts undergoing treatment at a tertiary care hospital.
Methodology:
This prospective observational study was done at the Department of Pediatric Surgery, Liaquat
University Hospital, Hyderabad, Sindh, Pakistan, from January 2017 to December 2021. In this
regard, a total of 78 children (age ≤ 14 years) with radiologically and/or serologically proven liver
hydatid cysts were recruited for this study. The analysis of the collected data considered
demographics, clinical presentation, diagnosis, treatment, complications, and patient outcome. The
patients recruited for the study were strictly followed-up for a minimum of 12 months following the
procedure.
Results:
The mean age is 8.4 ± 3.2 years, with a preponderance of males (53.8%). The most common clinical presentation was right upper quadrant pain (76.9%), followed by abdominal distention (42.3%).
Ultrasound had a diagnostic accuracy of 92.3%. Surgery was performed in 24 patients (30.8%), while
34 patients (43.6%) underwent percutaneous treatment and medical management alone in 20 patients
(25.6%). Cystobiliary fistula was found to be the most common complication in this series, with a
frequency of 6.4%. The recurrence rate was 3.8% at a mean follow-up of 18.6 months, with no
mortality.
Conclusion:
The hepatic hydatid disease in children can be effectively treated based on the stage and size of the
disease according to a treatment algorithm. Conservative surgery along with perioperative
albendazole treatment has proven successful. Early diagnosis can be facilitated and the prognosis
improved due to increasing awareness in the endemic region.
Keywords:
Hydatid cyst, Cystic echinococcosis, Liver, Child, Pediatric surgery, Pakistan.