3. Discussion
The literature review showed that Echinococcus multilocularis andE. granulosus were prevalent in Canidae in the area where the patient was living, and there were numerous reports of individuals being infected in that region2 . Although E. granulomatous infection most commonly affects the liver, this involvement is generally asymptomatic, and if the cyst grows, it can lead to hepatomegaly, which can have nonspecific symptoms, such as nausea, vomiting, and abdominal pain.
Cysts in the liver can cause problems in 40% of cases and create complications, such as infection, rupture, cholangitis, obstructive jaundice, and pancreatitis. The pressure of the effect of the mass on the bile ducts and portal and hepatic veins or on the IVC causes cholestasis and high blood pressure in the port (post hypertension, prehypertension) and Budd-Chiari syndrome or urethral obstruction in rare cases 5, 6. Vascular erosions, such as hepatic or vena cava veins, can also be other rare complications of hydatid cyst5.
The causes of portal vein thrombosis and cavernous transformation are numerous, which can often be due to cirrhosis , infection and hypercoagulopathy and can be a rare complication of hydatid cyst disease7, 8. Only three cases were reported of hydatid cyst invasion of the portal vein9. Hydatid cysts located in the region around the port can lead to thrombosis of the portal vein and cavernous 10. Its manifestations can be abdominal pain, fever, portal hypertension, or anaphylactic shock. The preferred treatment in these cases is surgery in addition to albendazole9.
Patients with hydatid cyst and thrombosis require the combination therapy of liver cyst and thrombosis or portal hypertension. Such treatments as albendazole, endoscopic retrograde cholangiography, and surgery to cure these patients were performed in cases reported from various countries, including Turkey, Spain, and Greece7, 8, 11. In a previous study conducted on six patients with thrombosis with hydatid cyst, two cases underwent surgery and the rest of them were subjected to endoscopic retrograde cholangiography 8, 10.
In another research, seven patients were investigated who were infected with Echinococcus with extensive involvement of the liver lobes and liver helium and eventually underwent a liver transplanted. Therefore, orthotopic liver transplantation can be considered a treatment option due to its beneficial results and the low possibility of recurrence12 .
ConclusionAlthough thrombosis and vascular problems in hydatid cyst are rare, this problem should always be considered and diagnostic tests related to these complications should be performed. It is recommended that the treatment consist of the combined treatment of hydatid cyst, thrombosis, and acute liver failure; moreover, surgery should be considered as an option if necessary.