Endoscopic Management of a Relapsing Hepatic Hydatid Cyst with Intrabiliary Rupture: A Case Report and Review of the Literature

Abstract

Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas.Endoscopic retrograde cholangiography with sphincterotomy has been successful as the sole and definitive means of treatment of intra-biliary ruptured hydatid cysts. A case of an elderly woman with frank rupture is presented, where the rupture was definitively managed endoscopically in conjunction with sphincterotomy to remove the intrabiliary obstructive daughter cysts and to achieve decontamination of the biliary tree.Endoscopic retrograde cholangiography provided an excellent diagnostic and therapeutic modality in the present case and, thus, it should be considered as definitive treatment in similar cases especially if surgical risk is anticipated to be high.

Surgical management of complicated hydatid cysts of the liver

“…Omentoplasty also protects against infection by promoting reabsorption of serosal fluid and by inducing macrophage migration in septic foci. Manouras et al [18] reported a case of an elderly woman with frank rupture into the biliary tract. The patient was managed by Table 4 Operative procedure for managing residual hydatid cyst cavity n (%)…”

Cysto-biliary communication in liver hydatidosis

“…Two theories have been postulated about its pathogenesis: the first asserts that the compression of the liver hydatid cyst on the wall of the bile duct (BD) causes progressive necrosis and finally the communication between the cyst and the biliary tree; the second postulates that after the trapping of small biliary radicals in pericystic wall, high intracystic pressure causes atrophy first and then subsequently the rupture of biliary radicals [17,18].…”

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.…”