Asymptomatic Liver Hydatid cysts; a Preferred Approach

Background: Surgery is the accepted method for treatment of complicated liver hydatid cysts. However, there is no consensus about the most appropriate management of incidentally discovered asymptomatic echinococcal cysts of the liver. Expectant management poses many patients at risk while operating all clinically silent liver hydatids, would impose burden on local health resources of endemic areas. Methods: We investigated 47 patients with clinically silent, ultrasonographically diagnosed liver hydatids during a period of one to ten years, to clarify the natural history of hepatic echinococcal cysts, Patients had a single asymptomatic liver hydatid cyst. We offered the patients to choose surgical treatment, or medical treatment with Albendazole. All patients declined both forms of treatment on grounds of not feeling particularly ill. Forty-three patients came back for regular followup visits lasted for 13 to 118 months. They were placed into three distinct groups, depending on their ensuing clinical course of disease. Results: Group A comprised of 16 patients whose initial complaints did not worsen nor developed new symptoms. In these patients the largest diameter of the cysts became smaller or the cyst disappeared completely. Group B consisted of 19 asymptomatic patients. Their liver cyst had increased in size from 2 to 7 cm with a mean diameter of 3.4 ern on ultrasound evaluation. Group C consisted of 8 patients who returned with complications of the cysts. Conclusion: Because of low rate of complications among incidentally discovered liver cysts, we suggest medical treatment for such patients. Operation can be reserved for complicated cases.