Clinical manifestations of polycystic hydatid disease presented in 26 patients treated in the Hospital das Clínicas in Ribeirão Preto, São Paulo State, Brazil

Abstract

In order to describe clinical manifestations of polycystic hydatid disease, it was analyzed the medical records of patients assisted from November 1978 to October 2008 in the Hospital das Clínicas in Ribeirão Preto, São Paulo State, Brazil. Among these patients, there were 26 ones with that disease and it was verified that the liver was the organ most often involved in 96.2%, the lungs 23.1% and both mesentery as spleen in 19.2%. Calcified cysts were detected in 84.6% of cases, indicating no recent illness. Weight loss, fever, nausea, vomiting, diarrhea, feeling of abdominal bloating and mainly epigastric pain in the right hypochondrium, in 80% of cases, preceded the appearance of complications. In the worst stage, the growth of cystic masses, compressing conducting structures of organic liquids, led to the most serious event: persistent jaundice observed in seven patients (26.9%), accompanied by signs of portal hypertension in six patients (19.2%), due to compression in the hepatic hilum. In three cases cholestasis followed the transdiaphragmatic access from the parasite to the thorax; in two cases cholestasis progressed to biliobronchial fistula. A patient died during the post-surgery period of therapeutic strategy and the other one survived after a biliary stent insertion. A patient with chronic cholestasis and portal hypertension had a fatal gastrointestinal bleeding. The rupture of cysts in bile ducts, defining temporary jaundice, was observed in five patients (19.2%). A spontaneous resolution of the cysts was observed in two patients. Admitting that recent cysts are more permeable to curative drugs, it is assumed that the recognition of the disease in its early manifestations will provide more efficient therapy.