ENDOSCOPIC TREATMENT OF COMPLICATIONS OF HYDATID CYSTS OF LIVER RUPTURED IN THE BILE DUCTS

Aims The objective of our study is to evaluate the contribution of endoscopic ERCP in the diagnostic and particularly therapeutic management of ruptured liver hydatid cysts in the bile ducts.

Methods Retrospective descriptive and analytical study, from January 2002 to August 2021, which included 50 patients with a hydatid cyst fistulized in the bile ducts. ERCP and endoscopic sphincterotomy were performed in all patients. Overall success was defined by definitive vacuity of the main bile duct.

Results Among the ERCPs performed in our department during the study period, 4.6%(n=50) were for a hepatic hydatid cyst communicating with the bile ducts.

The mean age was 46.1±14.8 years with a male predominance of 66%.

ERCP was performed in 52.2% of cases preoperatively, and in 47.8% postoperatively.

ERCP was indicated for acute angiocholitis in 44.9% and persistent external biliary fistula in 34%.

The median bile duct diameter was 10[7-14]mm and the median cyst diameter was 35[27-47].

Sphincterotomy was performed in 96% of patients allowing extraction of hydatid material by balloon or Dormia in 87.8%. Nevertheless 24% required naso-biliary drainage and 8% benefited from biliary prosthesis placement.

The overall success rate was 96% (n=46). The immediate complication rate was 8%(n=4), 1 patient had hemobilia and 3 patients had edge bleeding.

The evolution was marked by the disappearance of jaundice after 5 to 10 days.

Conclusions Our study confirms that endoscopic treatment of ruptured hydatid cyst in the bile ducts is an effective therapeutic alternative, with a low rate of immediate complications and a good long-term evolution.

Publication History

Article published online:
14 April 2022