Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description

Abstract

Background: Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has worldwide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction. Case presentation: We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it's further complications had not been observed before the operation. Conclusions: Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it's results depends on the invasion period the patient is operated on. After the surgery the patient requires careful followup, to detect early complications.

Risk Factors and the Character of Clinical Course of the Echinococcus multilocularis Infection in Patients in Poland

“…Recently, molecular biology tests have been used often in laboratory diagnostics. Polymerase chain reaction (PCR) with species-specific primers allows for a 100% confirmation of the E. multilocularis infection [ 22 ].…”

Young Age of Alveolar Echinococcosis Patient in Armenia: A Case Report

“…Almost 98% of AE cases are located in the liver and further spread into other organs ( 13 ). After a radical or sparing surgical treatment, the patient requires preferably two-year albendazole administration and appropriate follow-up ( 2 , 10 , 14 ). According to the WHO, the disease is frequently discovered at an advanced stage in many patients.…”

Dynamics of some physical and chemical properties оf biological fluids in surgical treatment оf alveolar hydatid disease of liver

“…Recently, in repeated operations on liver, doctors limited themselves to excision or curettage of fistulas, dissection of purulent cavities and injecting parasitotropic drugs [6][7][8][9]. There seems to be a real possibility to perform repeated radical operations on patients previously considered as "inoperable" [2][3][4][5][9][10][11].…”

“…According to Merzlikin et al (2011) and Błaszkowska, Góralska (2016), the development of surgery contributed to the fact that the majority of patients with focal liver lesions were not operated in specialized medical institutions [8,9]. Simultaneously, many of them due to technical complications and incorrect assessment of the operability of the lesion focus are limited to palliative surgery or exploratory laparotomy, thus dooming patients on disability and poor outcome [1,4,[10][11][12].…”