1. LIVER HYDATID CYST

2. CLASSIFICATION OF HYDATID CYSTS PRIMARY CYSTSPRIMARY CYSTS MULTIVESICULAR OR SECONDARY CYSTSMULTIVESICULAR OR SECONDARY CYSTS SECONDARY ABDOMINAL IMPLANTATIONSECONDARY ABDOMINAL IMPLANTATION

3. Natural history of liver hydatid 1 - Development of cyst – biliary communications 1 - Development of cyst – biliary communications 2 - Intrabiliary rupture 2 - Intrabiliary rupture 3 - Intraabdominal rupture 3 - Intraabdominal rupture 4 - Intrathoracic rupture 4 - Intrathoracic rupture 5 - Intrathoracic rupture 5 - Intrathoracic rupture 6 - Cyst death 6 - Cyst death

5. CLINICAL FEATURES 1 – Symptomless 2 –Painful or painless hepatomegaly 2 –Painful or painless hepatomegaly 3- Abdominal mass 3- Abdominal mass 4-Jaundice 4-Jaundice 5 - Intraperitoneal rupture 5 - Intraperitoneal rupture

6. DIAGNOSTIC STUDIES Serological testsSerological tests Imaging techniques 1 Ultrasonography 2 CT scan 2 CT scan 3 MRI 3 MRI 4 ERCP 4 ERCP

8. TREATMENT Medical treatmentMedical treatment bebzimidazole group bebzimidazole group Praziquantel Praziquantel

9. Indications of medical treatment 1 Inoperable cases 1 Inoperable cases - Site - Site - Multiple cysts - Multiple cysts 2 Concomitant diseases 2 Concomitant diseases

10. Contraindications 1 Pregnancy or lactation. 2 Heavily calcified cysts. 3 large cysts. 4 Obstructive jaundice.

11. Surgical treatment ObjectivesObjectives Remove all living cyst elements. Remove all living cyst elements. Prevent spillage. Prevent spillage. Close biliary communications. Close biliary communications. Sterilize cavity. Sterilize cavity.

12. Scolicidal agents 1- Hypertonic saline ( 3 % ). 2- Hydrogen peroxide 6%. 2- Hydrogen peroxide 6%. 3- Citeramide. 3- Citeramide. 4- Silver nitrate 0.5%. 4- Silver nitrate 0.5%. 5- Rectified spirit ( 96% ). 5- Rectified spirit ( 96% ). 6- Formalin 6- Formalin

13. Intrabiliary rupture Operative cholangiogram.Operative cholangiogram. Bile duct exploration.Bile duct exploration. T tube insertion.T tube insertion. CholedochoscopyCholedochoscopy.

14. Residual cavity management (1) Suture any obvious small bile duct openings (1) Suture any obvious small bile duct openings (2) Fill it with ordinary 0.9% saline(2) Fill it with ordinary 0.9% saline (3) Saucerize it by excising the protruding portion(3) Saucerize it by excising the protruding portion (4) Fill it with a graft of omentum.(4) Fill it with a graft of omentum. (5) Stitch the walls of the cyst (5) Stitch the walls of the cyst