Predictive factors of morbidity and mortality after surgical treatment of hepatic hydatid cyst with rupture into thorax

Background: Hydatid disease remains a serious health problem in Mediterranean countries. Complicated forms are frequent and require a complex management with significant morbidity and mortality rates. Thoracic rupture of hydatid liver cyst is rare and may cause lifethreatening complications. Methods: It is a retrospective study extending over a period of 24 years from 1992 to December 31, 2016 and investigating cases with hydatid cysts of the liver with thoracic rupture, treatment modalities, and factors of morbidity and mortality analyzed by a multivariate analytical study. Results: There were 47 women and 39 men, the mean age was 48 years with the age ranging from 13 to 85 years. Nineteen patients (22. 1%) were admitted in emergency. The most common symptom was the chest pain which occurred in 58 cases (67.4%); the other findings were cough [n:25 (29.06%)], dyspnea [n:37 (43.02%)] and fever [n:47 (54.65%)]. The main procedure was cystectomy and capitonnage with thoracophrenotomy and ‘Lagrot’ on the liver in 50 cases. Two patients underwent segmentectomy, two bilobectomy and 12 underwent lobectomy. Twenty three patients had a decortication. The overall mortality rate was 3.48% while the overall morbidity rate was 23.5%. Predictors of morbidity included advanced age (p=0.03), cysts larger than 7 cm (p=0.04), cysts with bilious contents (p=0.03), type II, III and IV on ultrasound classification (p=0.02)and patients operated lately(p=0.04), patients who underwent decortication or lobectomy(p=0.01). Conclusion: The hepatic hydatid cyst with rupture into thorax is a major complication of the hydatid cyst with a high morbidity and mortality.