Surgical Management of Spontaneous Intrabiliary Rupture of Hydatid Liver Cysts

Abstract

Purpose. The most common complication of hydatid liver cysts is spontaneous rupture into the biliary tract. This study was conducted to evaluate the surgical management of spontaneous intrabiliary rupture of a hydatid liver cyst in 41 patients. Methods. The preoperative diagnosis was confirmed by ultrasound in all 41 patients, 37 of whom were jaundiced. Results. According to Gharbi's classification, 39% of the cysts were type III and they ranged from 3 to 18 cm in diameter, with a mean diameter of 9 cm. The mean total bilirubin and alkaline phosphatase values were 6.3 mg/dl and 450 IU, respectively. Partial cystectomy, cholecystectomy, and common bile duct exploration were performed in all patients. In seven patients, the visible biliary duct within the cyst cavity was sutured with 2/0 silk. Intraoperative cholangiography was performed in all patients, and choledochoscopy was performed in 11 patients. A T-tube was inserted after the biliary tract content was thought to have been totally cleaned out in 38 patients (93%), and a choledochoduodenostomy was performed in 3 patients (7%). An external biliary fistula developed in five patients, persisting for 11-25 days. The fistulae healed within a mean period of 5 days after endoscopic sphincterotomy (EST). For patients without a fistula the mean hospitalization time was 8 days and there was no mortality. Conclusion. These results suggest that when a hydatid liver cyst ruptures into the biliary tract, common bile duct exploration should be conducted using intraoperative cholangiography and choledochoscopy. If the biliary tract is cleaned of all cystic content, T-tube drainage should be sufficient, but EST is an effective technique for treating persistent extended external biliary fistulae.

Treatment of hepatic hydatid disease complications using endoscopic retrograde cholangiopancreatography procedures

“…As a result, complications, such as obstructive jaundice and acute cholangitis caused by hydatid remnants in the biliary tree, can be seen during the pre-and postoperative periods. [6][7][8][9] If biliary communication persists after the initial surgery, bile collections or fistulas may develop, and persistent postoperative biliary fistula is a serious complication that often necessitates another surgery.…”

Cystobiliary communication in hepatic hydatid cyst: predictors and outcome

“…The principles of liver hydatid surgery include inactivation of protoscolices within the cyst fluid, evacuation of the cyst contents, prevention of content spillage, secure closure of any cystobiliary communications, and management of the residual cyst cavity (4)(5)(6). After a laparotomy and packing with hypertonic saline impregnated packs, two main types of procedures were done in this study group, radical surgery (peri-cystectomy and liver resection) and conservative surgery (deroofing and endocystectomy) with subsequent management of the resultant cavity by either marsuplization, omentoplasty, or drainage.…”

Open Surgery for Hepatic Hydatid Disease

“…20,21 The early diagnosis and treatment of cystobiliary communications are mandatory because they are associated with increased postoperative morbidity.…”

“…22,23 The clinical symptoms of cystobiliary communications are obstructive jaundice, abdominal pain, fever, and nausea/vomiting. 21,23 The spill of daughter cysts and fragmented membranes into the biliary tree can lead to obstructive jaundice, cholangitis, and septicemia. Occult rupture is seen in approximately 10% to 37% of cases.…”