Non-surgical Endoscopic Trans-papillary Treatment of Ruptured Echinococcus Liver Cyst Obstructing the Biliary Tree

Abstract

Previous reports showed that surgery is the only method of treating liver hydatid cysts that have ruptured into the biliary system. We report a case of obstructive jaundice due to spontaneous rupture of a liver hydatid cyst into the biliary system, which was treated non-surgically by endoscopic papillotomy and extraction of daughter cysts from the biliary system, insertion of a nasobiliary tube for drainage and injection of scolicidal hypertonic saline, into the biliary system. Clear resolution of the obstruction, disappearance of daughter cysts and a decrease in the size of the hepatic cyst was shown by ERCP, ultrasound and CT scan. We believe that this new method is safe, effective and has a lower incidence of mortality, morbidity and recurrence than surgery, which it should replace whenever possible.

Role of Different Treatment Modalities in Cavity Volume during the Treatment of Cystic Ecchinococcosis

“…However, an increasing number of reports have been published regarding endoscopic treatment for hydatid cysts with biliary rupture, and nowadays, ERCP has emerged as a safe treatment method (3,(14)(15)(16)(17)(18)(19)(20). In our report, 14 cases were treated with only ERCP+ES.…”

Albendazole in Hydatid Disease: Results in 22 Patients

“…Endoscopic evacuation of ruptured cyst into the biliary tree has an excellent outcome but this procedure has limited value as it can only be used in liver cysts communicating with the biliary tree [5,19,21]. From other studies as well as our own, albendazole has shown encouraging results in treatment and in preventing recurrence following surgery.…”

“…A liver cyst may rupture into the biliary tree resulting in obstructive jaundice. Cyst infection may also occur [5].…”

Biliary Infections

“…Endoscopic intervention plays an important role when intra-biliary rupture of the hydatid cyst occurs [42,43] or in the management of biliary complications following surgery [30,[44][45][46][47].…”