Intrabiliary rupture: an algorithm in the treatment of controversial complication of hepatic hydatidosis.
OBJECTIVE
Intrabiliary rupture (IBR) is a common and serious complication of hepatic hydatid cyst. The incidence varies from 1% to 25%. The treatment of IBR is still controversial. We aimed to design an algorithm for the treatment of hepatic hydatidosis with IBR by reviewing our cases.


METHODS
Eight cases of IBR were analyzed retrospectively. Patients were evaluated according to age, sex, clinical findings, cyst number and stage, abdominal ultrasonography and CT-scan, surgical methods, complications, results and coincidental diseases.


RESULTS
Female/male ratio was 1/7. Mean age was 52.12+/-18.26 years (range 24-69 years). Right upper quadrant pain, flatulence, palpable hepatic mass were symptoms common in all patients. Cholestatic jaundice was found in four cases. In all patients, cyst evacuation and omentoplasty were performed, followed by either choledochoduodenostomy, T-tube drainage, intracavitary suturing of the orifice, two cases in each. Whereas in two patients diagnosed post-operatively percutaneous drainage of biliary collection or ERCP and sphincteroplasty were added. Morbidity and hospital stay were higher in these cases.


CONCLUSIONS
When the diagnosis of IBR can be done pre- or intra-operatively, morbidity decreases. If a biliary fistula is seen post-operatively, endoscopic procedures such as ERCP, sphincteroplasty or nasobiliary drainage can be applied.
Erzurumlu
Kenan
K
Department of Surgery, Medical School, Ondokuz Mayis University, 55139 Kurupelit, Samsun, Turkey. kerzurum@omu.edu.tr
Dervisoglu
Adem
A
Polat
Cafer
C
Senyurek
Gokhan
G
Yetim
Ibrahim
I
Hokelek
Murat
M
D000328:Adult; D000368:Aged; D000465:Algorithms; D000871:Anthelmintics / Q000008:administration & dosage; D001562:Benzimidazoles / Q000008:administration & dosage; D001658:Biliary Fistula / Q000469:parasitology* / Q000601:surgery; D002768:Choledochostomy; D004322:Drainage; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000469:parasitology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture
D000871:Anthelmintics; D001562:Benzimidazoles; C031000:benzimidazole