title: Frank intrabiliary rupture in liver hydatidosis located in the hilar plate: a surgical challenge.
abstract: BACKGROUND
  Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment.
  
  
  METHODS
  Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child.
  
  
  RESULTS
  In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolved by percutaneous drainage (1 patient). There was no mortality. During follow-up (47 months), no recurrences of the disease or biliary strictures were recorded.
  
  
  CONCLUSIONS
  FIR is a severe complication of liver hydatidosis. When it is located in the hilar confluence, liver resection may be the best surgical option for definitive resolution of the problem.
authors.affiliation: Unidad de Cirugía Hepatopancreatobiliar, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ramia
authors.forename: Roberto
authors.initials: R
authors.lastname: De-la-Plaza
authors.forename: Jose
authors.initials: J
authors.lastname: Quiñónes
authors.forename: Farah
authors.initials: F
authors.lastname: Adel
authors.forename: C
authors.initials: C
authors.lastname: Ramiro
authors.forename: Jorge
authors.initials: J
authors.lastname: García-Parreño
mesh_terms: D000328:Adult; D004444:Echinococcosis, Hepatic / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome