Liver cysts (HCL) caused mostly by the tapeworm Echinococcus granulosus are a substantial yet unrecognised public health concern in poor nations such as India [1]. In 2010 the World Health Organisation (WHO) estimated that the incidence of cystic echinococcosis per 100,000 individuals in Southeast Asia was 0.8 (95% confidence interval (0.2-2)) [2]. Still, estimating HCL's influence in India is difficult for several reasons. First off, the total prevalence of the illness is greatly underreported in many epidemiological studies and series due to a lack of thorough research and surveys across the whole endemic population. Subsequently, the Health Management Information System, the government of India's surveillance system, tends to underreport may provide insufficient information on parasite zoonosis, including HCL..

Throughout its life cycle, Echinococcus has three hosts: a dog, which acts as the definitive host; an intermediate host, such as a sheep, goat, or cow; and on occasion, an accidental host, which is a person. It has been reported that 2–5% of domestic dogs in India are infected with E. granulosus [4]. It is traditional to slaughter domestic animals and feed their raw organ meat to domestic dogs. The surroundings and food that are polluted by the eggs that are generated in their faeces may be one way that the disease is spread to humans. The clinical indicators of an Echinococcus infection depend on the cyst's size and location. When the cyst is small, there may not be any symptoms in the early stages of the infection [5]. Eventually, HCL may As the illness progresses, symptoms may include nausea, vomiting, hepatomegaly, and pain in the right upper quadrant or epigastric area of the abdomen [6].

Imaging investigations are often used in concert with immunodiagnostic techniques to help in the diagnosing process [7, 8]. Ultrasonography (USG) is the initial imaging modality of choice for figuring out the number, location, size, and longevity of cysts since it is easy to use, widely available, and moderately priced [9]. Antibody testing might confirm the imaging diagnosis that was initially thought. However, echinococcosis is seldom ruled out by a negative serologic test [10]. Computed tomography (CT) scans and magnetic resonance imaging (MRI) can be used to detect deep-seated lesions and evaluate the size and condition of avascular fluid-filled cysts [6].

Treatment options for HCL include surgery, medication, percutaneous techniques, and observation. Surgical cystectomy has been the standard and recommended treatment for HCL in the long run [11]. But alternative therapeutic techniques such cyst puncture, aspiration, chemical injection, and reaspiration (PAIR) have progressively replaced surgery as the primary course of treatment, and in some cases even completely replaced it [6, 12]. Because it reduces the likelihood of recurrence, chemotherapy based on albendazole is commonly used in conjunction to other kinds of treatment [4]. In this study, we looked at the HCL therapy, clinical symptoms, and demographic characteristics at FM MCH, Balasore. The purpose of this study is to provide useful information to doctors on the epidemiology and clinical picture of the illness in a developing nation.

This investigation was carried out over the course of 24 hours in the general surgery department of the FM Medical College and Hospital in Balasore. A descriptive analysis of patients with HCL that was done retrospectively is included in the research. Nursing admission data from the surgical department was used to diagnose instances of hydatid cysts. all available medical records.

Individuals who had extrahepatic hydatid cysts but no liver damage were left out of the study. In the investigation, 23 individuals with HCL were included. The diagnosis was made using Enzyme-linked immunosorbent assay-based serology and imaging scans (ELISA). The presence and extent of hepatocellular and extrahepatic hydatid cysts were determined and evaluated using a USG and a CT scan, either in combination or independently. The cysts are classified according to the WHO categorization method based on the classification of HCL's USG and CT appearance.

As treatment approaches, our patient group received surgery, improved catheterization techniques, PAIR therapy, albendazole therapy, and monitoring. The experts considered the cyst's size and type while determining the best course of action.

The study's findings were obtained by recording clinical and surgical data from patients and statistically analysing them with IBM SPSS 23.0.

The patients' average age was 36, with the age range of 25 to 45 being the most frequently afflicted (10, 43.47%). The majority of the patients were female (56.5%). The most frequent symptoms were abdominal pain (21, 91.3%) and palpable liver (7, 30.4 %).

Table 1: Demographics Of The Study Population (n = 23).

Table 2: Clinical Features In The Study Population.

Table 3: Cyst Characteristics In USG And CT Abdomen.

Table 4: Involvement Of Different Lobes Of The Liver (N = 22).

Table 5: Modalities of treatment.

In India, echinococcocosis is a serious public health concern. Liver is the organ where echinococcal infections are most commonly detected. [13] Consequently, the general public is more aware of HCL. Estimates of racial and ethnic characteristics, medical symptoms, and HCL therapy among patients getting hospital care at a tertiary hospital in India are among the outcomes of this work.

Our analysis indicates that 36 is the median age. Complementary to studies by Jastaniah et al. and Hazra et al. [4, 14]. Our study also indicates that the most common age range for HCL sufferers is between 25 and 45 years old. There is a sizable workforce in the most economically active age group, which is between 25 and 45 engaged in agriculture and animal husbandry, which is a significant source of HCL.

The male to female ratio in our study was 0.8 (43.5 % male, 56.5 % female), which is in line with the results from Abebe et al. and Ahmadi and Hamidi [15, 16]. In India, women actively participate in farming, taking care of the home, and caring for animals. This practice is crucial in rural regions of the country since a significant percentage of the youth male population departs to pursue economic possibilities abroad, leaving the female population to handle all activities relating to agriculture and animals. It's possible that females are more prone to contract HCL as a result of the parasite.

The two most prevalent symptoms among the participants in our study were fever and abdominal discomfort. According to Biluts et al. [17], 84% of the research group's presenting symptom was abdominal discomfort. An Ethiopian research found that 97.6% of the patients reported having stomach ache. Fever was the most frequent presenting symptom in the same sample, followed by nausea, vomiting, and loss of weight [16]. On the other hand, fever was more common in our study than symptoms including nausea, vomiting, malaise, and weight loss. The increased incidence of fever (26.1%) is probably due to the larger percentage of people in our research sample who had infected hydatid cysts. Palpable liver and abdominal discomfort was the most common physical finding in the clinical assessment of our research cohort. As this The results align with a research conducted by Hazra et al., which found that 49.5% of the patients had varying degrees of hepatomegaly [18]. The biggest dimension of the cyst in approximately thirty percent of the participants in our research was greater than 10 cm.

The diagnosis in our patients was established on the basis of serology data, USG, CT, and clinical symptoms. However, not all patients were able to employ the USG, CT scan, and immunodiagnostic technique at the same time to confirm the diagnosis due to budgetary limitations. USG has a sensitivity of 90 to 95% for the evaluation of Echinococcus [19]. Due to its low cost and excellent sensitivity, USG is an affordable and practical investigative method in a low-income country like India. The most commonly detected ultrasonographic finding in our research was the heterogeneous echoic pattern of the cyst, which was followed by its unilocular and anechoic appearance. According to a study by Niron et al. evaluating the USG appearance of HCL, 40 of 65 cysts showed the the most common traits, which are round, unilocular, and anechoic; very few patients have anomalous USG results. [20]

The unilocular, simple cystic lesion is the most common result on CT imaging in our research cohort, which confirms our USG findings. Cysts with calcified walls were easier to find with CT than with USG. This disparity may stem from the fact that USG is more effective than CT in identifying minute calcifications inside cysts when a cyst is still actively growing [21]. We discovered that the right lobe of the liver was where hydatid cysts were most commonly observed in the research cohort. Alghoury et al. discovered in their Yemeni study that 65.78% of isolated cases of hepatic cystic echinococcosis had an impact on the right lobe of the liver [22]. Our results are consistent with research from Greece and Nepal. This states that the most common location for HCL is the right lobe [4, 23]. The right lobe of the liver is more severely affected than the left lobe because of the nature of portal blood flow [24]. The available expertise and technology, the size and kind of cysts, and the patients' adherence to long-term follow-up all affect the treatment option [25]. Several writers recommend surgery as the only course of treatment since it is the most efficient technique to eliminate cysts and results in a full recovery [26, 27, 11]. In 47.8% of the patients in our research, hydatid cysts were surgically removed.

The most prevalent form of surgery in the research population was partial pericystectomy. This result aligns with a research by Bayrak and Altintas, which discovered that the majority of procedures carried out on HCL patients were either open surgery, laparoscopic surgery, or partial pericystectomy [28]. Hazra et al.'s research revealed that partial pericystectomy is a tissue-sparing technique. Furthermore, in contrast to alternative surgical methods, its simplicity and safety benefit the patient as well as the surgeon [4]. The surgical indications that were given at the 2009 expert conference of the WHO-Informal Working Group on Echinococcosis closely match those of our research cohort. The most frequent symptoms are infectious cysts, cysts that are near to the skin and may burst, and liver cysts with daughter vesicles.

cysts compressing surrounding tissues, cysts communicating with the bile ducts, and cysts for whom percutaneous surgery is not an option [27]. For patients who were deemed ineligible for surgery, less invasive treatment options such as albendazole monotherapy, PAIR, and modified catheterization technique were used. Alternative modalities of therapy, if not contraindicated, can serve as excellent substitutes for surgery in underdeveloped and economically disadvantaged areas. Treatment for active cysts larger than 5 cm, including unilocular and membrane-detachable cysts, is mostly accomplished using PAIR [29]. Albendazole is advised for patients unable to undergo surgery, active cysts smaller than 5 cm, and those with numerous cysts in various organs as well as peritoneal cysts [27, 30].

The liver's hydatid cyst is a major public health concern in India that is often untreated. The clinical and social reaction to HCL may be planned using the study's data on the illness's demographics, clinical features, and treatments. Increasing public knowledge of the illness and ensuring that USG facilities are available across India are imperative. Multicentric study with a larger sample size should be able to explain the disease's epidemiological trend.

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