Hydatid Cyst of Liver Ruptured in the Portal Vein

Abstract

Introduction: The rupture of a hydatid liver cyst in the portal system is an exceptional complication. It has been reported only few observations in the world literature. We report a case a patient that we operated on for a complicated hydatid liver cyst. Observation: This is a 46-year-old patient, a professional driver with a hunting dog hospitalized in the surgical department for obstructive jaundice. Abdominal ultrasonography, computed tomography and magnetic resonance imaging diagnosed 3 hydatid cysts in stage III of Gharbi accompanied by partial thrombosis of the portal vein with an absence of visualization of its right branch. The exploration operation revealed the existence of 3 hydatid cysts that communicate with each other and destroy half of the right liver. At the end of the total cystectomy, a communication of the cyst with the right branch of the portal vein was highlighted and the evacuation of the daughter vesicles followed by a major hemorrhage. The daughter vesicle was evacuated and the right branch of the portal vein was ligated and the bile ducts drained by a transcystic drain. The postoperative complications were complicated by a biliary fistula which dried up on the 19th postoperative day. The patient was discharged from the service on the 30th postoperative day. Currently, he is on Albendazole tablet 400mg / day with well health. Conclusion: The rupture of a hydatid cyst in the portal system remains rare and its diagnosis is well established by modern examinations such as ultrasound, computed tomography and magnetic resonance imaging. The treatment involves surgery and Albendazole but remains quite difficult.

Rupture of a liver hydatid cyst into the right portal vein leading to right portal vein thrombosis: a case report and literature review

“… 3 , 9 This complication can lead to several problems, such as portal hypertension and anaphylactic shock due to the leakage of antigenic material from the cyst. 10 , 11 Therefore, it is important to make a rapid diagnosis of cystovascular fistulas and treat this condition as a surgical emergency.…”

“…1 In previously reported cases, the hydatid cysts were treated surgically only in three cases. 1 , 11 , 12 One case was treated with endoscopic retrograde cholangiography, and five patients received albendazole. 3 , 10 , 12 , 15 , 16 Portal hypertension is treated with beta-blockers to reduce portal pressure, endoscopic ligation of esophageal varices, and percutaneous or surgical shunt surgery in some cases.…”