Chlorhexidine Gluconate: An Ideal Scolicidal Agent in the Treatment of Intraperitoneal Hydatidosis?
Injection of scolicidal solution into the hydatid cysts has been used to sterilize the cyst and to prevent intra-abdominal dissemination of the parasite during surgery. We report six cases of complications of this measure. Intraoperative collapse in one patient and an immediate postoperative death occurring after injection of 10% H202. Postoperative sclerosing cholangitis occurred in 4 patients in whom 2% formalin or 20% sodium chloride was injected into the cyst. Cholangiography showed strictures affecting the intrahepatic biliary tree in 2 and both the intra and extra biliary tree in 3. Sclerosing cholangitis in these patients was likely to result from the caustic effect of the scolicidal solution having diffused from the cyst into the biliary tree. Jaundice developed in 3 patients from 2 to 5 months after operation. The intra-operative collapses is related to the injection of H202 into the cyst. The dramatic increasing of the volume of the cyst may fissure of the cyst-wall and allows the passage of gaz into the circulation. As the efficacity of intracystic injection of a scolicidal solution in preventing the dissemination of the parasite is still unproven, we recommend the rejection of this maneuver in the surgical treatment of hydatid disease of the liver.