Intrabiliary rupture of hydatid cyst of the liver.

In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69-1 per cent) and intrabiliary rupture occurred in 15. Pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right, shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. Chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases. Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.