Ahmet Tekin, Tevfik Küçükkartallar, Faruk Aksoy, Metin Belviranlı, Murat Çakır, Bülent Erenoğlu

Selçuk Üniversitesi Meram Tıp Fakültesi Genel Cerrahi AD, KONYA


Purpose: Rupture of the hydatid cyst of the liver into bile ducts is a rare and serious complication of hepatic hydatid disease. Operative treatment of intrabiliary ruptured hydatid cysts has many differences to uncomplicated cysts. We report our experience, including surgical approach to the intrabiliary ruptured hydatid disease.

Materials and Methods: Between January 1985 to December 2005, 640 patients with hydatid cysts of the liver underwent surgery, and 62 patients (13 %) with intrabiliary rupture of hepatic hydatid cysts were retrospectively reviewed.

Results: Of 62 patients, 35 were men and 23 were women. Their average age was 39 (28-74) for men and 43 (15-63) for women. Biliary ruptured hydatid cysts were all in liver. The right lobe of the liver was involved in 48 patients (77 %), the left lobe in 12 (19 %) and both lobes in 2 patients. Each had only one cyst except one patient who had two cysts in two lobes. One patient had recurrent hepatic hydatid cyst who had been operated on 7 years ago. The most common clinical manifestations were right hypocondrial pain and tenderness in the right hypocondrium on physical examination. Methods used for diagnosis were ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography (ERCP). Five of the patients healed after ERCP and endoscopic sphincterotomy. In these patients common bile duct (CBD) was explored and it was drained by a T-tube in 35 patients, by a choledochoduodenostomy in 8 patients and hepaticojejunostomy in one patient. Bile fistula orifice was sutured in 12 patients. Twelve patients had wound infection and 2 patients had bile leak postoperatively. There was no mortality.

Conclusion: The low mortality and morbidity rates in the treatment of intrabiliary rupture of hydatid cysts can be obtained with surgical intervention to CBD with T-tube drainage and choledochoduodenostomy. In selected cases ERCP and endoscopic sphincterotomy are adequate methods for diagnosis and treatment of intrabiliary ruptured hydatid cysts.

Keywords: Liver hydatid cyst, cyst rupture into bile ducts, hydatic cyst.