Figure 1: Hydatic cyst’s constitutive parts
Figure 2: Proligere membrane
plombage, drainage of the cavity by anastomosis with
the stomach/jejunum, pericysto-biliar drainage. It should
also be mentioned that hepatic transplantation might be a
treatment option when at least 25-30% of the total hepatic
parenchymal volume cannot be saved, or in the case of
para- or post-hydatic hepatic cirrhosis [10]. The opening
of the cystic cavity must be preceded by the inactivation of
the parasite with a hypertonic saline solution, ethyl alcohol,
hydrogen peroxide or Albendazole. It is also necessary to
isolate the cyst from the rest of the peritoneal cavity, either
by wrapping the adjacent areas with dressings soaked in
anthelmintic substances or by applying adherent cones to
the cyst using the icing technique or suction [11]. Resolving
the remaining cavity is the primary challenge of the open
surgical approach. In a study belonging to Mousavi et al.,
it is concluded that omental plumbing is superior to the
drainage of the remaining cavity as it reduces the risk of
seeding the peritoneum with germs [12].
Laparoscopic interventions are primarily suited for
cysts located superficially on the anterior surface of the
Table 1: WHO-IWGE classification of the hydatid cyst
Stage Echographic aspect according to WHO-IWGE Classification CL
Anechogenic uniloculated cyst, with no echoes or
internal sepsis
CE 1
Anechogenic cyst, with fine echoes inside,
representing the hydatic sand - active cyst
CE 2
Cyst with multiple septums at the interior,
giving it a multivesicular aspect or “honeycomb”
aspect,with a uniloculated primary cyst - active
cyst
CE 3
Uniloculated cyst with decolated proligere
membrane (“waterlily sign”) (CE3a) or daughter
vesicles associating hypo/hyperechogene images
(CE3b) - cyst in transition phase
CE 4
Cyst with mixed content, hypo/hyperechogenic,
without daughter vesicles - “wool clew” aspect-
cyst in the degenerative phase
CE 5
Cyst with partial or totally calcified wall - inactive
cyst