Dr Deepak Varma Gastro Surgeon Cochin

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Hyatid cyst

Hyatid cysts are a result of parasitic infestation caused by the genus Echinococcus which is a tapeworm. They remain asymptomatic even after they have advanced. The degree of symptoms depend on the size of the cysts, the site and the load of the parasite.


There are four types of echinococcosis:

  • Cystic echinococcosis or CE: this is extremely common in endemic areas and is caused due to E.granulosus
  • Alveolar echinococcosis or AE: also very common and spreads due to E.multilocularis
  • Polycystic echinococcosis: results due to E.vogeli
  • Unicystic echinococcosis: infection of E.oligarthrus


  • Larval cestodes of phylum Platyhelminthes or tapeworms
  • Poor hygiene in animal and personal
  • Feeding dogs raw offal
  • Regular contact with dogs
  • Ingestion of undercooked pork meat

Signs and symptoms

Hyatid cysts in the liver is usually asymptomatic. In advanced stages or if complications develop, it can be symptomatic. Reveal jaundice, abdominal pain and palpable mass; rupture of the cysts in the liver will spill contents into the bile duct and peritoneal cavity and lungs causing urticaria, fever and anaphylactic reactions


Physical examination:

  • Jaundiced skin
  • Urticaria
  • Erythema
  • Spider angiomas indicative of cirrhosis of the liver
  • Vital signs hypotension with anaphylaxis due to cyst leak
  • Lungs airway obstruction, decreased breath sounds
  • Abdomen tender hepatomegaly, abdominal tenderness, ascites, splenomegaly

Blood tests: indirect hemagglutination test and enzyme-linked immunosorbent assay or ELISA. This is commonly known as hydatid serology.

Imaging studies:

  • Ultrasound
  • CT scan
  • MRI

Ultrasound and CT scan tests are usually diagnostic of hydatid cysts. These also help to characterize and delineates the exact anatomical location of the cyst before surgery.


In the case of cystic echinococcosis, if liver cysts are large, superficially located and single, they have a chance to rupture. A total pericystectomy or partial resection of the affected organ is indicated. Liver hydatid cysts can often be tackled with laparoscopy. Surgery is undertaken after a course of medical therapy. Meticulous and careful surgical intervention is needed to avoid and prevent spillage of the fluid into the abdomen. Inadvertent surgery can cause spread of the disease in the abdomen.

My team are adept at handling both cases of AE and CE very effectively.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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