THE INTRABILIARY RUPTURE OF LIVER HYDATIDOSIS

Abstract

Rupture into the biliary system is a major complication of multivesicular hydatid cyst of the liver. Growth of the echinococcal cysts cause displacement, distortion and stenosis of the hepatic ductules with impaired bile drainage. The hydatid cyst can rupture into the biliary tract due to long term compression; causing biliary colic, obstructive jaundice and possibly liver abscess. The aim of this study is to discuss our clinical experience about the intrabiliary rupture of liver hydatidosis. In the last 11 years, patients treated for intrabiliary rupture of liver hydatidosis at our department were retrospectively reviewed. After removal of the echinococcus cyst, obliterating the biliary openings with inverting sutures in 12 (42.8%) of the cases. T tube drainage in 6 (21.4%) and choledocho-duodenostomy in 2 (7.2%) cases had been performed in the presence of choledochal occupation by echinococcus cyst. Secondary bacterial infection was the most common post-operative complication (46.4%). However, when the diagnosis is not safe enough, the surgeon must be alert about intrabiliary rupture of the liver hydatidosis at the presence of gelatinous material in the common bile duct. In the presence of intrabiliary rupture, the closure by inversion suture of the ectocyst is mandatory. In any choledochal communication with the ectocyst, choledochal exploration and T tube drainage must be kept in mind. Choledocho-duodenostomy may be an alternative procedure when the choledochal dilatation is more than 2 cm.