Diagnosis and treatment of mixed infection of hepatic cystic and alveolar echinococcosis: Four case reports

BACKGROUND: Mixed infection of hepatic cystic and alveolar echinococcosis is extremely rare. This article reveals the typical imaging manifestations of cystic and alveolar echinococcosis and investigates the diagnosis and surgical experience of mixed infection of hepatic cystic and alveolar echinococcosis. CASE SUMMARY: From January 2017 to May 2019, 4 cases with rare mixed infection of hepatic cystic and alveolar echinococcosis were admitted and treated by the Division of General Surgery of Qinghai Provincial People's Hospital. Three of the patients occasionally had upper abdominal discomfort, but it did not affect their daily lives. However, hepatic echinococcosis was found in one patient by physical examination, and the patient had no discomfort. All 4 cases were Tibetans who had lived in pastoral areas of southern Qinghai for a long time. Enzyme-linked immunosorbent assay for echinococcosis was positive for all patients. Moreover, abdominal computed tomography showed typical imaging manifestations of cystic and alveolar echinococcosis including coexisting “honeycomb sign,” and “spotted calcification.” Three of the patients underwent radical resection, and 1 case underwent palliative resection. All 4 patients developed different types of surgical complications after the operation, but all of them recovered and were discharged after symptomatic treatment. CONCLUSION: There are no problems diagnosing mixed infection of hepatic cystic and alveolar echinococcosis. The difficulties involve preoperative evaluation and treatment of surgical complications.