Intrabiliary and abdominal rupture of hepatic hydatid cyst leading to biliary obstruction, cholangitis, pancreatitis, peritonitis and septicemia: a case report

Abstract

Background Hydatid cysts are fluid-filled sacs containing immature forms of parastic tapeworms of the genus Echinococcus. The most prevalent and serious complication of hydatid disease is intrabiliary rupture, also known as cystobiliary fistulae. In this study, a sporadic case of biliary obstruction, cholangitis, and septicemia is described secondary to hydatid cyst rupture into the common bile duct and intraperitoneal cavity. Case presentation A 21-year-old Iranian man was admitted to the emergency ward with 5 days of serious sickness and a history of right upper quadrant abdominal pain, fatigue, fever, icterus, vomiting, and no appetite. In the physical examination, abdominal tenderness was detected in all four quadrants and in the scleral icterus. Abdominal ultrasound revealed intrahepatic and extrahepatic biliary duct dilation. Gallbladder wall thickening was normal but was very dilated, and large unilocular intact hepatic cysts were detected in segment IV and another one segment II which had detached laminated membranes and was a ruptured or complicated liver cyst. Conclusion Intrabiliary perforation of the liver hydatid cyst is an infrequent event but has severe consequences. Therefore, when patients complain of abdominal pain, fever, peritonitis, decreased appetite, and jaundice, a differential diagnosis of hydatid disease needs to be taken into consideration. Early diagnosis of complications and aggressive treatments, such as endoscopic retrograde cholangiopancreatography and surgery, are vital.

Intra‐biliary hydatid cyst rupture: A rare case report with superinfection

“…Follow‐up after eight months revealed minor fibrosis of the liver cyst and normal antibody levels 14 . Conservative surgery, including partial cyst resection, removal of cyst contents, and sterilization of the remaining cavity, was performed in our case and in studies 16–18 . Wani et al gave albendazole as part of postoperative management 18 .…”

“…We identified cyst calcifications using CT as well as in Becker's case 14 . Conversely, Aghajanzadeh et al and Avcu et al find normal cyst wall without calcifications 16,17 …”

“…14 Conversely, Aghajanzadeh et al and Avcu et al find normal cyst wall without calcifications. 16,17 An intact cyst is naturally resistant to infection owing to the avascularity of the pericyst and limited interaction with the host blood system. However, once the cyst ruptures, bacterial infections become possible, 11 approximately 25% of the ruptured cysts become infected.…”

“…Moreover, concomitant rupture of HHC in the gallbladder and intrabiliary duct is rare. 16,18 CT scans are useful for observing calcifications of the cyst wall, internal septa, daughter vesicles, and identifying any disseminated cysts. 15 We identified cyst calcifications using CT as well as in Becker's case.…”

“…15 In our case, it revealed a distinctive beaver-tail liver appearance, indicating cystobiliary communication between the HHC located in segments IV and V and the biliary tree; however, Avcu et al and Aghajanzadeh et al reported ruptured HHC in segment II, which is the most common liver segment to have a ruptured HHC. 16,17 The presence of daughter vesicles within biliary ducts can result in different complications like obstruction, 16,17 cholecystitis, 16 choledochocystitis, and acute cholangitis 17 (Table 1). An enlarged gallbladder is a common complication in such cases, either with wall thickening, 18 or without 16,17 ; however, delayed time of detection might be the cause of wall thickening in some cases.…”