Intrabiliary rupture of an hydatid cyst of the liver: Combined surgical and interventional radiologic approach to treatment
Echinococcal cysts of the liver often remain asymptomatic for years until adjacet structures are compressed or deformed. Rupture of an echinococcal cyst into the biliary tree is a common complication of hydatid disease occuring in up to 25% of cases and presents with jaundice, biliary colic, malaise and at times urticaria and fever. Serological investigations, CT and ERCP are the most important investigations, endoscopic sphincterotomy may improve the situation in patients with rupture of small cysts. The presence of a dilated common bile duct in the presence of rupture of a big hydatid cyst is an indication for surgical duct exploration. Drainage of the biliary system is essential for the treatment of suppurative cholangitis and obstructive jaundice, but simple T-tube drainage is inadequate because it frequently becomes occluded by debris or daughter cysts. A widely patent biliary-enteric anastomosis, therefore, provides efficient drainage of the biliary tree. We present a new method of drainage of the biliary tree using a Roux-en-Y-hepaticojejunostomy modified for post-operative radiological intervention in a 72-year-old farmer with rupture of a big cyst of the caudate lobe. Extensive daily direct irrigation through a tube introduced through the Roux-en-Y loop into the big cyst completely evacuated the remaining cystic material and debris. The therapy was completed by adjuvant chemotherapy with albendazole. At clinical examination with CT over 2 years post-operatively no evidence of recurrent disease could be found.