Refractory Cystobiliary Fistula Secondary to Percutaneous Treatment of Hydatid Cyst: Treatment with N-Butyl 2-Cyanoacrylate Embolization

Abstract

A 27-year-old female with a type 2 hydatid cystic lesion in the liver according to the Gharbi classification (CE 3A according to the WHO classification) was referred for percutaneous treatment after albendazole treatment for 1 year. A catheterization technique was performed but hypertonic saline and alcohol were not given into the cavity due to cystobiliary leakage. During the 4-month follow-up period, sequential cavitography revealed biliary fistula, and bile-stained drainage had not been ceased despite the sphincterotomy, nasobiliary drainage catheter, and plastic stent. Since the patient refused to surgery, we embolized the biliary fistula using N-butyl 2-cyanoacrylate for the first time in the literature. At the 3-month follow-up, the patient's course was uneventful and ultrasound, multidetector-row CT, and MRI examinations revealed no collection in or adjacent to the cavity.

An integrated surgical training program for hepatic cystic echinococcosis in Xinjiang of China

“…HCE can, therefore, be regarded as a failure of primary prevention policies, in turn conferring significant economic and physical burdens on patients, healthcare infrastructures, and society. Surgery remains the only radical treatment for cystic echinococcosis, but postoperative recurrence (3.2-22%) and residual cavity complications (10-47%) remain common [5][6][7][8][9][10][11][12][13]. This is especially true in Xinjiang Province.…”

Echinococcosis

“…Perioperative albendazole prophylaxis is needed to prevent secondary dissemination and reduces the rate of reactivation after surgery (4.2-6.7 % vs 9.4-23.3 %, with vs without albendazole, respectively) (Arif et al 2008;Gollackner et al 2000). Bile leakage from biliary fistulae and cyst cavity superinfection are the most common complications of surgical interventions (4-14 %) and are managed either conservatively or surgically (Agarwal et al 2005;Canyigit et al 2011;Bedirli et al 2002;Dziri et al 2009;Galati et al 2006;Manterola et al 2003;Prousalidis et al 2008;Caremani et al 2007;Smego and Sebanego 2005). Important cautionary measures are the following: (1) perioperative treatment with albendazole and protection of the surgical field with pads soaked with scolicidal agents to prevent secondary CE and relapses; (2) avoidance of scolecidal agents, in case of open surgery, if cystobronchial or cysto-biliary fistulae are observed (the latter by visualization of the fistula, presence of bile-stained cystic fluid, detection of bilirubin in the fluid, or by cholangiography); and (3) appropriate management of the residual cavity (Junghanss et al 2008).…”

Partial Cystectomy and Omentoplasty for Liver Hydatid Cyst

“…15 When ultrasound and CT scan do not provide the necessary information, especially in case of extrahepatic cysts or the serological tests are inconclusive, then MRI can be used as an alternative diagnostic modality for the diagnosis of hydatid disease. 2,16,17 The treatment modality of hydatid disease should be selected for each patient individually according to patient preference, age, and concomitant disease. These patient related factors affect the treatment plan and also pose a risk for surgical intervention.…”