Echinococcosis remains an endemic surgical problem in many Mediterranean countries. We report our experience with such cases when the disease is located in uncommon sites, outside the liver and lungs. This study was an effort similar to a previous one but with more cases and additional information. Between 1967 and 1994 a total of 49 patients suffering from hydatid cysts located in various organs other than the liver and lungs presented to our clinic. There were 28 men and 21 women, with their ages ranging from 10 to 66 years and 22 to 80 years, respectively. Among these patients, 25 had the parasitic cyst in the peritoneal cavity, 10 in the spleen, 5 in the kidney, 3 in the spinal column, 2 in the retroperitoneal space, 1 in the abdominal wall, 1 in the myocardium, 1 in the thoracic wall, and 1 in the thigh. Their hospital stay was 9 to 88 days (average 27 days). Only two patients--one with cardiac hydatidosis and one with spinal hydatidosis--died postoperatively. Three patients with multiple cysts in the peritoneum and one with cysts in the thigh had recurrences of the disease and were reoperated successfully.

Clinical manifestations of an abscess were identified in 75% of the patients. In the earlier cases of the study, the diagnosis was made from the clinical picture, laboratory studies, in combination with plain X-ray, hepatic scintigraphy, and in the later cases with US (ultrasonography), CT (computed tomography) or MRI (magnetic resonance imaging), and ERCP (endoscopic cholangiopangreatography). Abdominal and, rarely, thoracic and abdominal or thoracoabdominal incisions were used. Total cystopericystectomy in 8 patients and partial pericystectomy and proper drainage with one or two drainage tubes of the cystic cavity in the other 69 patients were carried out. Hospital stay was between 13 and 146 days with 5 re-operations. Two patients with grossly suppurated cysts and coexistent medical problems died. The disease recurred in five patients. CONCLUSIONS. We conclude that, under good perioperative antibiotic and metabolic coverage, the infected hydatid cysts have to be completely evacuated and properly drained. The application of "conservative" surgical procedures should be preferred. Further studies are needed to solve the clinical and therapeutic problems of this serious complication.

Background: Surgical management is the basic treatment for hydatid disease. Overall, the recurrence rate appears to be high (4.6%-22.0%). The purpose of this study was to report our results in the management of recurrent hydatid disease, evaluating the methods for identifying recurrence, prognostic factors and therapeutic options. Methods:We retrospectively reviewed the medical records of patients who underwent surgery for cystic hydatidosis between 1970 and 2003.