Endoscopic management of hepatic hydatid cysts ruptured in the biliary ducts

Aims Hepatic hydatid cyst usually runs asymptomatically, while clinical symptoms, are usually due to complications that supervene. The most commonly encountered complication is rupture into the biliary tree with secondary biliary obstruction by intracystic material and cholangitis. The aim of our study is to evaluate the contribution of endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnostic and particularly therapeutic management of ruptured liver hydatid cysts in the bile ducts.

Methods We conducted an ambispective descriptive study, from January 2014 to June 2024, which included 55 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, 4.2% (n=55) 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%.For our 55 patients included in the study, ERCP was performed in 56% of cases before surgical management of hydatid cyst, and in 44% postoperatively.ERCP was indicated for acute cholangitis in 44.9% of the cases and for persistent external biliary fistula in 34% of the cases.The median bile duct diameter was 10mm[7-14] and the median cyst diameter was 35mm[26-47].Sphincterotomy was performed in 96% of patients allowing extraction of hydatid material by balloon or Dormia in 87.8% of the cases. Nevertheless 20% required naso-biliary drainage and 8% benefited from biliary stent placement. The overall success rate was 97% (n=53). The immediate complication rate was 7%(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 and by the drying up of the external biliary fistula after 10 days.

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

Publication History

Article published online:
27 March 2025