Management of frank intrabiliary rupture of hepatic hydatid cyst
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Background: Among the complications of hydatid liver disease, frank intrabiliary rupture is a rare complication. Our therapeutic policy and various problems that we faced in dealing with this complication are discussed here. Patients and Methods: During the last 24 years, 214 patients underwent surgery for liver echinococcosis. Those 20 patients (9.3%) who had frank intrabiliary rupture of hydatid cysts were examined retrospectively. The main symptoms in these patients were jaundice and pain while the most common clinical sign was a mass in the right upper quadrant. In all patients the cysts ruptured into the biliary tree, and the cystobiliary fistula were sutured with absorbable sutures. Unroofing procedure was performed in all patients. Capitonnage was carried out in 4, omentoplasty in 4 and external tube drainage in 15 patients. All 20 patients had common bile duct exploration. Clearance of daughter cysts and cyst remnants by transduodenal sphincteroplasty was supplemented in 3 patients, by choledochoduodenostomy in 2 patients, and by Roux-en-Y cystojejunostomy in 1 patient. Results: There was no mortality. Morbidity was 15%. Complications included wound infection in 2 patients and respiratory infection in 1 patient. Mean ( +/- SD) hospital stay was 12 +/- 3 days. No recurrence of the disease was seen during a mean follow-up of 8.4 years. Conclusion: A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event, and one should be aware of it in differential diagnosis of obstructive jaundice.