Retrospective analysis of liver hydatid cyst in children

Objective: In this study, it was aimed to evaluate the clinical and demographic characteristics of pediatric patients who applied to our clinic for liver hydatid cysts. Material-Method: This is a retrospective type III descriptive study. The study included 214 liver hydatid cyst patients who were diagnosed and treated in our clinic between January 1, 2010 and December 30, 2022. The data of the patients were retrospectively collected. The patients were divided into two groups as group 1 (medical treatment) and Group 2 (PAIR + Surgery). The patients' age, symptoms, diagnosis, laboratory parameters, diagnostic methods and treatment methods and results were evaluated. Results: A total of 214 patients, 56% (n=119) of whom were women, were included in our study. The mean age of the patients was 11.05±3.83 years [range: 1-18]. In our study, a total of 361 hydatid liver cysts were detected. Single cyst in 68% (n=145), two cysts in 18% (n=39), three cysts in 6% (n=13) and four or more in 8% (n=17) liver cyst was detected. Isolated liver cyst was detected in 86% (n=184) of the patients. Liver + lung cysts were detected in 20 patients, liver + spleen in 5 patients, liver + intra-abdominal cysts in 2 patients, liver + kidney in 1 patient, liver + kidney + brain in 1 patient, and liver + rectus muscle cyst in 1 patient. Higher eosinophils were found in 55%, direct bilirubin in 37%, ALT in 28%, AST in 22%, GGT in 17% and amylase in 5% of patients. The type of cyst is according to the WHO classification at the time of application; 46% were CE 1, 11% CE 2, 15% CE 3A, 12% CE 3B, 11% CE 4 and 5% CE 5. In 66.8% of the patients, the cysts were located on the right side, 21% on the left side, and 12.1% on both the right and left sides. The 33.6% (n=72) of the cysts were small (<5 cm), 45.3% were medium-sized (5-10 cm) and 21.1% were large (>10 cm). The mean cyst size was 66.97±34.23 mm, [median= 60; range: 8-180]. The 66% (n=142) of the patients were followed non-operatively. While 76% of these patients were followed with albendazole treatment, 24% were followed without treatment (watch & wait). When watch & wait (CE 4-5) patients were excluded, the number of patients in need of treatment was 180. Of the 180 patients, 40% were treated operatively and 60% non-operatively. Twenty-eight patients underwent PAIR. When one of the patients who underwent PAIR did not benefit from the treatment, open surgery was performed on the patient later on. Two PAIRs were performed on one patient, one year apart. Forty-four patients underwent surgery (laparoscopy=7, laparotomy=37). The area under the curve for the prediction of multiple cysts, the EMR and EMR index, respectively, was 0.819 and 0.820; cut-off value 0.86 and 1.5; sensitivity was calculated as 88% and 88%, and specificity 64% and 64%. The area under the curve for the prediction of large cyst (>10 cm), the GGT and GGT index, respectively, was 0.757 and 0.757; cut-off value 18 and 74; sensitivity was calculated as 86% and 85%, specificity 63% and 63%. EMR can predict the unilateral-bilaterality of the cyst. When EMR, AUC: 0.80 and cut-off: 1.13 were selected, sensitivity was 85% and specificity 65%. Conclusion: Surgical approach is important in the treatment of hepatic hydatid cyst in children. There are still some difficulties in diagnosis. Laboratory blood results and developed indices can be helpful in predicting the number of cysts, the size of the cyst and the number of lobes where the cyst is located.