Endoscopic treatment of ruptured hepatic hydatid cysts in the bile ducts

Aims The aim of our study is to evaluate the contribution of endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnostic and especially in the therapeutic management of ruptured hydatid cysts in the bile ducts.

Methods This is a retrospective descriptive and analytical study conducted between January 2005 and August 2024, involving 50 patients with fistulised hepatic hydatid cyst in the bile ducts. All patients underwent ERCP and endoscopic biliary sphincterotomy. Overall success was defined as definitive vacuity of the main bile duct. Statistical analysis was performed with JAMOVI software.

Results Hepatic hydatid cysts communicating with the bile ducts accounted for 4.6% (n=50) of the ERCPs performed in our department during the study period. The mean age was 46.1±14.8 years, with a male predominance of 66%, giving a sex ratio (M/F) of 1.94. ERCP was performed preoperatively in 52.2% and postoperatively in 47.8% of the 50 patients included in the study. ERCP was indicated for acute angiocholitis in 44.9% and persistent external biliary fistula in in 34%. The median bile duct diameter was 10 [7-14] mm and the median cyst diameter was 35 [27-47] mm. Sphincterotomy was performed in 96% of patients, allowing extraction of hydatid material by balloon or Dormia in 87.8% of cases. However, 24% required naso-biliary drainage and 8% benefited from a biliary prosthesis. The overall success rate was 96% (n=46). The rate of immediate complications was 8% (n=4): one patient had haemobilia and 3 patients had edge bleeding. The evolution was marked by the disappearance of jaundice after 5 to 10 days and by the the drying up of the external biliary fistula after 10 days.

Conclusions Our study confirms that endoscopic treatment of ruptured hydatid cysts in the bile ducts is an effective therapeutic alternative, with a low rate of immediate complications (8%) and a good long-term outcome.

Publication History

Article published online:
27 March 2025