D: The result of infection with adult tapeworm (Echinoccocus granulosus)

G: Common in mediterranean

P: Large parasitic cyst grows slowly and asymptomatically

• Can have pressure effects on organs
• Can Rupture (can also release daughter cysts within them)
• Cysts can become infected with bacteria

Life Cycle

• Ingestion of canine tapeworm eggs (dogs are asymptomatic)
• Eggs hatch in duodenum + embryos cross mucosal membrane
• Travel via portal blood supply to liver
• Primary site of infection is the liver (can affect any organ in body)

S: Can present as acute abdomen from minor trauma from rupture

• Rupture: pain
• Into biliary tract: Obstructive jaundice, cholangitis

S:

I: Diagnosis is by serology and scans

• Serology/ELISA assay - Enzyme Linked ImmunoSorbent Assay for antibodies to hydatid antigen
• USS: Multiloculated cysts
• CT: "floating membrane"

T: Albendazole chemotherapy. Surgical enucleation is required occasionally.

• Chemotherapy: Albendazole/Mebendazole
• Percutaneous hypertonic saline and alcohol
• Surgery: (1) complete resection (2) local excision of cysts (3) de-roofing of cyst with evacuation of contents. Contamination of peritoneal cavity at time to surgery should be avoided by continuing drug therapy.