Non-operative Management of Asymptomatic Liver Hydatids Cysts

For the past 90 years all asymptomatic hydatid cysts of the liver are routinely removed surgically to prevent serious complication. The mortality of such operations are above 6 %, while major complications of untreated liver hydatid cysts are less than 6 %. The best way to manage incidentally discovered asymptomatic liver hydatid cysts is to fully understand their natural history : 1) The pericyst layer surrounding most liver hydatid cysts will become thicker and calcified. Such changes are known as PDCs (Pericyst Degenerative Changes) on computed tomography (CT) and indicate that these cysts can no longer grow in size and, therefore, need not to be operated upon. They can be followed up by CT ( not sonography or magnetic resonance imaging [MRI] ) at intervals of 1-5 years, and no sooner, to avoid radiation exposure. Albendazole can be prescribed for them under supervision if they show no PDCs on CT. Mild, intermittent pain of abdomen or flank is not a sign of complication. 2) The inside field of hydatid cysts on CT and not sonography or MRI) should be inspected at intervals of 1-5 years. Finding any structures ( usually some lines) suggests that there has been detachment of the parasite from the host, called LMD( Laminated Membrane Detachment). These cysts will reach involution or develop daughter cysts over next 10 years, and also need not to be operated upon. Patients who develop jaundice, sever pain and fever, or have air in their cysts on CT, or have developed complications need to be operated upon, including ERCP (Endoscopic Retrograde Cholangio Pancreatography).