Cholecysto-Hydatid Cyst Fistula: A Rare Cause of Cholangitis

Abstract

Patient: Female, 76-year-old Final Diagnosis: Left hepatic cyst hidatic fistula to gall bladder Symptoms: Biliary colic • icterus • Sepsis Medication: — Clinical Procedure: Multidiscipliner treatment Specialty: Surgery Objective: Rare disease Background: Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. Case Report: A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. Conclusions: We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

Rupture of Hydatid Cyst in the Gallbladder Leading to Acute Cholangitis

“…Following common biliary duct investigation and biliary lavage, T-tube drainage or transduodenal sphincteroplasty may be carried out, particularly if fistula is larger than 5 mm and if preoperative endoscopic retrograde cholangiopancreatography (ERCP) was not performed [ 10 ]. The preoperative ERCP obviates the necessity of choledochotomy and T-tube drainage by performing sphincterotomy or stent placement [ 11 ].…”

“…e preoperative ERCP obviates the necessity of choledochotomy and T-tube drainage by performing sphincterotomy or stent placement [11].…”

Gallbladder Hydatid Disease Complicated with Multiple Hepato-biliopancreatic Fistulae: A Case Report

“…Hydatid disease (HD) usually affects liver and lungs, caused by the parasite Echinococcus granulosus . Liver localization may lead to rupture into the bile ducts as seen in some cases ( 1 ). Such situations can cause major clinical problems during the follow-ups like prolonged biliary fistula.…”

“…Likewise, infrequently hydatid cysts may also invade gallbladder and pancreas, affect the organs, and lead to organ dysfunctions. Concomitant intrahepatic bile duct, gallbladder, pancreatic duct and common bile duct invasions of the hydatid disease are extremely rare ( 1 ). This combination will most likely deter the situation in a swift fashion, leading to cholangitis, jaundice, cholangiosepsis and most importantly anaphylaxis.…”