The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Management of Intra-Biliary Rupture of Liver Hydatid Cysts (IBRH): Follow-Up of 12 Cases

Abstract

Background: Intra-biliary rupture of hydatid cyst [IBRH] is not a rare complication of hydatid disease of the liver and surgery until recently is the only definitive treatment. With the introduction of ERCP preoperatively or postoperatively there was a great reduction in the operative complications. There were reports in which the ERCP was the sole treatment of this condition. Objective: To evaluate role of ERCP in the management of cases of IBRH. Design: A retrospective study of 7 cases of IBRH and prospective study of 5 cases of IBRH managed by ERCP. Setting: The ERCP Unit of Kurditan Center for Gastroenterology & Hepatology, Asulaimaneyah-Iraqi, Kurdistan, Iraq. Main Outcome Measurements: Improvement in the symptoms, obstructive liver functions pattern and ultrasonic findings in these patients following ERCP management. Methods: This is a study of 12 cases of IBRH managed by ERCP in the Kurdistan Center of Gastroenterology (KCGE) in Asulaimaneyah-Iraq, from 2007-2010. Seven cases of these were studied retrospectively from the available information on the center computers and on follow-up of these patients, while the other five patients were studied prospectively during the study period. We collected the available information: laboratory investigations, trans-abdominal ultrasonography (TAUS), computed tomography (CT) or magnetic resonance images (when available), before and after ERCP. We depended on the liver functions, trans-abdominal ultrasound and the clinical presentation before and after the ERCP; some patients were contacted via mobile phone for follow-up. Results: Cases were more males than females (58% vs 42%); most were from the ages between 30-50 years. The clinical presen

Clinical presentation, diagnosis and surgical treatment of intrabiliary ruptured hydatid disease of the liver

“…When an IBR is diagnosed preoperative or during operation, there are need treatment with surgery of hepatic hydatid cyst (3,4,5,7). Cystic material should be evacuation, removal of laminated membrane and doughter cysts, irrigation of cystic cavity are necessary (11,12,13,21). If orifice leakage site is seen and no cystic content is observed in a normal size of CBD, suturing the orifice is sufficient to prevent fistula (26,27,28).…”

“…Intrabiliary rupture (IBR) is the most common and serious complication of hepatic hydatid cyst (HHC) (5,10,12). The incidence varies from 1% to 25% although an incidence of 64.75% has been reported from a multicentric study in Tunisia [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Early diagnosis and therapy are mandatory in the case of an intrabiliary rupture of a liver hydatid cyst, which can result in the obstruction of the biliary duct with 50% mortality [4][5][6][7]14].…”

Adverse Outcomes of Endoscopic Retrograde Cholangiopancreatography at Gastroenterology and Hepatology Centers in Sulaymaniyah and Duhok City

“…In Kurdistan, the ERCP is an effective and safe therapeutic and, to a lesser extent, a diagnostic method commonly for biliary stones, intra-biliary rupture of hydatid cyst, post-cholecystectomy complications, and rarely pancreatic pathologies in the last two decades (15,16) . Although widespread use of ERCP in Iraqi and Kurdistan centres, there was a scarcity of kinds of literature discussing the adverse outcomes following ERCP.…”