Cysto-biliary communication in liver hydatidosis

Abstract

The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. The percentage of patients with the communication between the cyst and the biliary tree is not well known because there is no accepted definition. The therapeutic options are multiple and related to the size of the communication, the location of the cyst, and the experience of the hepatobiliary surgeon. ERCP is now an important tool for the treatment of the communication between the cyst and the biliary tree.

Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

“…Post-operative biliary leakage occurred in 11.4% of our study group, which was similar to the rates reported in several studies (5,12,13,19,29,30). These patients were managed either conservatively, with ultrasound guided tube drainage or ERCP with ultrasound guided drainage of the abdominal bilomas.…”

“…Several reports in the literature addressed the methods to effectively diagnose and predict the presence of CBF (14,18,19).…”

Biliary Complications of Hepatic Hydatid Cyst Surgery and Prevention Methods

“…Since intracystic pressure is higher than the biliary pressure, frank CBC allows the cystic contents such as daughter cysts or membrane fragments to enter the biliary system and leads to clinical symptoms like obstructive jaundice, cholangitis, cyst infection, or anaphylaxis. Its incidence varies between 3 and 17% in liver hydatid cyst patients [6,11]. If frank CBC is wider than 5 mm, cystic contents can be seen in the bile ducts during the preoperative evaluation in up to 65% of the patients [11].…”

“…Such necrosis may lead to a communication between the cyst and the biliary system. The second one suggests that small biliary radicals, which are trapped in the pericystic membrane, become atrophic due to the cystic pressure and rupture eventually [11]. Even though some studies stated communication rates up to 90% during the cysts evolution, the reported incidence of clinical CBC is only 13-37% [8,11].…”

“…It can be classified as "low-flow fistula" if the daily drainage volume is less than 300 ml/day or "high-flow fistula" if more than 300 ml/day [8,9]. If the fistula persists more than 3 weeks or is a high-flow fistula, then endoscopic or surgical intervention should be considered rather than a conservative approach [8,10,11]. …”