Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature.
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 intrabiliary 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.
Manouras
Andreas
A
First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, Athens, Greece. amanouras@hippocratio.gr
Genetzakis
Michael
M
Antonakis
Pantelis T
PT
Lagoudianakis
Emmanuel
E
Pattas
Michael
M
Papadima
Artemisia
A
Giannopoulos
Panagiotis
P
Menenakos
Evangelos
E
D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D012422:Rupture, Spontaneous; D016717:Sphincterotomy, Endoscopic