Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst

Gaspare Galati, Antonio V. Sterpetti, Maria Caputo, Marianna Adduci, Giorgio Lucandri, Stefania Brozzetti, Antonio Bolognese, Antonino Cavallaro

Research output: Contribution to journalArticle

Abstract

Background: Hydatid disease affects most commonly the liver, and rupture into the bile ducts is a frequent complication, occurring in 5% to 25% of cases. These complications can cause major clinical problems either preoperatively or postoperatively with post-resectional abscess or prolonged biliary fistula. We reviewed our experience with preoperative endoscopic retrograde cholangiography (ERC) and the diagnosis of major cyst-biliary fistula. Methods: During a 7-year period, 78 patients underwent surgery for hepatic hydatid disease. Ten patients, in whom a major intrabiliary rupture of the cyst was suspected on the basis of clinical and radiological criteria, underwent preoperative ERC, with clearing of the biliary tree. Endoscopic sphincterotomy was performed in 7 cases when the fluid contained daughter cysts or pus. Three patients, in whom the biliary content was fluid only, did not undergo sphincterotomy. One patient in whom a preoperative ERC was not feasible underwent operative transduodenal sphincterotomy. In all 11 patients the cyst was resected. Two patients underwent preoperative ERC, but no fistula was detected .They were compared with the remaining group of 67 patients who underwent resectional surgery during the same period, for apparently uncomplicated echinococcal cysts, and with an historical group of 569 patients operated on from January 1966 to January 1995. Results: According to the clinical and radiological preoperative criteria, there were 2 false positives. Preoperative ERC allowed visualization of the fistula, clearing of the biliary tree, and sphincterotomy in selected cases. The incidence of postoperative fistula was significantly decreased after the introduction of selective preoperative ERC, on the basis of preoperative clinical and radiological criteria. Conclusions: Preoperative ERC is very helpful in patients with cyst-biliary fistula, allowing visualization of the fistula and drainage of the biliary tree, and reducing the incidence of postoperative complications from 11.1% to 7.6%. In selected cases it can solve the problem, without further surgical therapy.

Original languageEnglish
Pages (from-to)206-210
Number of pages5
JournalAmerican Journal of Surgery
Volume191
Issue number2
DOIs
Publication statusPublished - Feb 2006

Keywords

  • Biliary fistula
  • Cyst
  • Endoscopic cholangiography
  • Hydatid disease
  • Liver surgery
  • Parasitic cyst

ASJC Scopus subject areas

  • Surgery

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  • Cite this

    Galati, G., Sterpetti, A. V., Caputo, M., Adduci, M., Lucandri, G., Brozzetti, S., Bolognese, A., & Cavallaro, A. (2006). Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. American Journal of Surgery, 191(2), 206-210. https://doi.org/10.1016/j.amjsurg.2005.09.014