162 BRIEF COMMUNICATIONS

Management of hepatic echinococcosis in pregnancy

Kathrin Pallua a, Guenther Putz a, Gottfried Mitterschiffthaler a, Christoph Brezinka b,
Matthias Biebl c, Peter Paal a,⁎
a
Department of Anesthesiology and General Critical Care Medicine, Innsbruck Medical University, Austria
b
Department of Gynecology and Obstetrics, Innsbruck Medical University, Austria
c
Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Austria

a r t i c l e i n f o
During pregnancy, a physiological decrease in cellular immunity may
Article history:
facilitate echinococcus growth [2]. Cyst rupture can cause potentially
Received 2 November 2009 life-threatening anaphylaxis and peritoneal infection during labor [3].
Received in revised form 28 December 2009 Thus, we decided to deliver the baby by cesarean delivery. To mitigate
Accepted 25 January 2010 the severity of potential anaphylaxis, we administered an H1-receptor
antagonist (diphenhydramine 30 mg; Dibondrin, Montavit, Absam,
Keywords:
Adverse birth outcomes
Anesthesia
Austria) and an H2-receptor antagonist (famotidine 20 mg; Ulcusan,
Millennium
Cesarean Development Goals
delivery Kwizda Pharma, Vienna, Austria), as well as methylprednisolone
Prenatal care
Echinococcosis 250 mg (Urbason; Sanofi-Aventis, Vienna, Austria) before cesarean
Peru
Liver delivery.
Stillbirth
Pregnancy
Albendazole may be used after the first trimester of pregnancy
without teratogenic effects, and may eradicate echinococcus but may
not alter cyst size [3]. With medical treatment, an expectant policy
A 29-year-old woman presented with left flank pain at 20 weeks ofmay be justified in small (b5 cm) asymptomatic, or totally calcified
pregnancy. She had lived in Turkey during her childhood. Ultrasoundcysts. In our case, the cysts were large and continued to grow despite
and magnetic resonance imaging revealed 3 partially calcified hepaticalbendazole, but enabled us to delay cesarean delivery. Definite
cysts with a maximum diameter of 9.6 cm and echinococcus treatment—hepatic resection—was performed later.
multilocularis was confirmed serologically. Pharmacological treat- In conclusion, one should be aware of the potential hazards of
ment with albendazole (Eskazole; GlaxoSmithKline, Vienna, hepatic echinococcosis during labor. Albendazole may be employed to
Austria) was started, but the cysts continued to enlarge. prevent cyst growth. Cesarean delivery under spinal anesthesia, with
Vaginal delivery was discussed, but deemed too risky owing to prophylaxis against anaphylaxis, should be considered in patients
potential rupture of the hepatic cysts during labor. An elective cesarean with large echinococcus hepatic cysts to prevent potentially life-
delivery under spinal anesthesia was performed in the 34th week threatening cyst rupture during labor. If postnatal hepatic cysts are
of pregnancy without complications. Cyst enlargement continued large and growing despite albendazole, surgical treatment may be
despite albendazole therapy, and an extended right hepatectomy was indicated [4].
performed 3 months later. Histology revealed multiple cysts without
viable protoscolices. The patient had an uncomplicated recovery and Conflict of interest
was discharged on the seventh postoperative day. Follow-up 6 months
after delivery was uneventful. The authors have no conflict of interest to declare.
Echinococcosis is endemic in the Mediterranean region, Middle and
Far East, Africa, and South America, with an incidence of approximately References
200 per 100 000 [1]. In North America and Europe its incidence is lower
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Pregnancy impairs the innate immune resistance to Salmonella typhimurium
leading to rapid fatal infection. J Immunol 2007;179(9):6088–96.
[3] van Vliet W, Scheele F, Sibinga-Mulder L, Dekker GA. Echinococcosis of the liver
during pregnancy. Int J Gynecol Obstet 1995;49(3):323–4.
⁎ Corresponding author. Department of Anesthesiology and Critical Care Medicine,
[4] Stoĭkov S, Popov I. A rare case of generalized echinococcosis and pregnancy. [in
Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Tel.: + 43 512 Bulgarian]. Akush Ginekol (Sofiia) 1999;38(3):47–51.
504 80448; fax: + 43 512 504 22450.
E-mail address: peter.paal@uki.at (P. Paal).

0020-7292/$ – see front matter © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijgo.2009.12.009