A patient with echinococcosis may develop a cutaneous fistula. Sometimes this is the first sign of the parasitic infection.
Clinical features:
(1) The patient has a hydatid cyst, usually in the liver but also lung or spleen.
(2) The patient may have another fistula - to bile duct, gastroinetestinal tract, bronchus, heart, pleural cavity or peritoneum.
(3) The amount of drainage at initial rupture may be significant.
(4) The fistula may open at the umbilicus, abdominal wall or chest wall.
Risk factors:
(1) older adult
(2) diabetic
(3) aggressive echinococcosis
(4) infected hydatid cyst
(5) following surgery for hydatid disease
Contrast-enhanced fistulography prior to surgery can help to define the extent of disease and can help in planning the operation.
Management involves resection of the underlying cyst, excision of the fistula tract and medical therapy (albendazole, benzimidazole, amphotericin B, other).
