ENDOCOPIC MANAGMENT OF FISTULISED HYDATID CYST IN THE BILE DUCTS

Aims To precise, the role of ERCP in the management of fistulised hydatid cysts in the bile ducts.

Methods A retrospective and descriptive study was carried out over 3 years, including all patients who have had an ERCP for fistulised hydatid cyst in the bile ducts.

Results 570 ERCPs have been conducted in 3 years, 17 cases was included; the indication was fistulised hydatid cyst in the bile ducts. The mean age was 44 years (25–62 years) with a female predominance (64.7 %), 58.8% was originated from rural backgrounds; three patients have had a history of liver hydatid cyst surgery while one patient had a percutaneous treatment 2 months before. 76.4 % of patients presented with cholangitis. The Abdominal ultrasound showed the hydatid cyst and an intrahepatic biliary dilatation. Sectional imagery (CT scans or MRI) were realized for all patients showing intra hepatic dilatation in 94.1 of cases, CBD dilatation in 82.3% of cases and intraluminal materiel in the CBD in 35.3% of cases. ERCP was realized for all patients, before surgery for 13 patients and after surgery for 4, retrograde catheterization of the CBD was realized in all cases. The opacification showed a dilatation of the CBD in 70.5% of cases and a disparity of the caliber of the CBD in one case while the hydatid cyst was opacified in one case (5.8%), Sphinterotomy was realized in all cases, the extraction of the hydatid material was conducted with a balloon in 94.1% of cases and with a dormia in one case. In 58.8% of cases, hydatid membranes and/or vesicles were observed. No post ERCP complications were observed with a cilinical and biological improvement post intervention.

Conclusions The results of our study confirm the efficiency and safety of ERCP in the management of ruptured hydatid cysts in the bile ducts.