Role of endoscopic retrograde cholangiography in ruptured hepatic hydatid cyst

Abstract

Aim: To report endoscopic retrograde cholangiopancreatography (ERCP) findings of intrabiliary hydatid cyst rupture Material and methods: A retrospective study of cases with intrabiliary rupture of hydatid cyst was conducted. A total of 4 cases (all female with a mean age of 32 years) were included. ERCP and ultrasound data were evaluated. Assessment involved number, location, size, internal and wall characteristics of cyst; intrahepatic biliary radicle dilatation (IHBRD); common bile duct (CBD) dilatation and evidence of extrabiliary rupture on ultrasound. ERCP evaluation included IHBRD, CBD dilatation, communication between cysts and intrahepatic biliary radicles (IHBR) and filling defects within the IHBR and CBD. Treatment details were also obtained.Results: A total of 5 cysts were evaluated in 4 patients. Left lobe cysts were most common (n=4). Segment II/III were the most commonly affected segments (n=3). Cyst outline was smooth and cystobiliary communication noted in all cases. Deformation of cyst wall was noted in 2 cases. Isolated (left or right) IHBRD lateralised to the side of the cyst was most common (n=4). CBD dilatation was seen in all cases with a mean calibre of 1.4 cm. Concomitant extrabiliary rupture was seen in 3 cases. Endoscopic management was done in all cases without complications. Three patients underwent surgical excision after a mean period of 8 weeks following ERCP.Conclusion: Isolated IHBRD lateralized to the side of hydatid cyst with CBD dilatation is the commonest ERCP finding of intrabiliary rupture of hydatid cyst.

A Challenging Case of Refractory Biliary Leak in a Patient With Hydatid Liver Disease

“…It is mostly occult due to small tears and communication between the cyst and the biliary radicals or less likely frank rupture involving large biliary ducts. Rupture occurs mostly centrally and is precipitated by physical trauma, and excessive coughing or vomiting [7][8][9]. Dew was first who described IBR and mentioned that rupture mostly occurs in the biliary ducts of the right liver lobe followed by those of the left liver lobe and rarely in the CBD [8,10].…”

“…Although the routine preoperative use of ERCP in an uncomplicated HD is not accepted yet, some centers advise its use to define the anatomy of biliary tree and evaluate for any cysto-biliary communication and thence decrease postoperative complications [8]. ERCP has been considered the mainstay in evaluating biliary communications as the direct visualization of the communication between the cyst and the biliary radicals is the most reliable method [9]. However, in about 0-30% of patients with suspected frank IBR (i.e., presented with jaundice and/or dilated bile ducts) and who underwent ERCP, only external bile duct compression by the cyst was observed [8].…”

Interventional radiological management of hepatobiliary disorders in pregnancy

“…It is considered teratogenic in the first trimester and hence contraindicated during this period. A larger cyst usually requires intervention due to the associated risk of rupture [ 74 ]. Surgical treatment in the later stages of pregnancy is associated with an increased risk of breach of the cyst and associated complications as well as precipitation of labor [ 75 ].…”

Current Treatment of Hydatid Liver Disease: Surgical Perspective

“…Ultrasonography is helpful in diagnosing hydatid cyst when daughter cysts are visualized, but it is operator-dependent. Computerized tomography scan is very accurate in diagnosing hydatid liver disease and differentiating it from other benign liver cysts such as amoebic and pyogenic cysts [8].…”