S E Kornaros1, T A Aboul-Nour. 1. Third Department of Surgery, Tzanio Teaching Peripheral Hospital, Piraeus, Greece.
Abstract
BACKGROUND: Frank intrabiliary rupture of hydatid hepatic cyst is a common complication in patients with echinococcal cysts of the liver. The early diagnosis of this condition with early and appropriate operative intervention can save a high number of these patients from death. STUDY DESIGN: Of 208 patients with hydatid cysts of the liver, 27 patients (13 percent) had intrabiliary rupture of the cyst. These 27 patients were managed as follows. Intrabiliary lavage of the debris remnants and biliary contents was done first, followed by radical treatment of the hepatic cyst, and finally safe drainage of the biliary tree through a T tube, choledochoduodenal anastomosis, or sphincterotomy. For radical treatment of the cyst and the residual cavity, we performed an excision of the dome and external drainage of the cavity in 17 cysts, a marsupialization in nine cysts, a partial pericystectomy in three cysts, and a reduction of the cavity and external drainage in two cysts. RESULTS: The patients were followed up for as many as 14 years, and with the exception of one patient, no complications related to the method of treatment occurred. CONCLUSIONS: The ideal treatment for intrabiliary rupture of hydatid hepatic cyst after early diagnosis is traditional lavage of the biliary tree, followed by radical treatment of the cyst and free drainage of the bile ducts. With this method, hepatectomy and cystojejunostomy and their drawbacks and complications are avoided.
BACKGROUND: Frank intrabiliary rupture of hydatid hepatic cyst is a common complication in patients with echinococcal cysts of the liver. The early diagnosis of this condition with early and appropriate operative intervention can save a high number of these patients from death. STUDY DESIGN: Of 208 patients with hydatid cysts of the liver, 27 patients (13 percent) had intrabiliary rupture of the cyst. These 27 patients were managed as follows. Intrabiliary lavage of the debris remnants and biliary contents was done first, followed by radical treatment of the hepatic cyst, and finally safe drainage of the biliary tree through a T tube, choledochoduodenal anastomosis, or sphincterotomy. For radical treatment of the cyst and the residual cavity, we performed an excision of the dome and external drainage of the cavity in 17 cysts, a marsupialization in nine cysts, a partial pericystectomy in three cysts, and a reduction of the cavity and external drainage in two cysts. RESULTS: The patients were followed up for as many as 14 years, and with the exception of one patient, no complications related to the method of treatment occurred. CONCLUSIONS: The ideal treatment for intrabiliary rupture of hydatid hepatic cyst after early diagnosis is traditional lavage of the biliary tree, followed by radical treatment of the cyst and free drainage of the bile ducts. With this method, hepatectomy and cystojejunostomy and their drawbacks and complications are avoided.