J Korean Med Sci.  2012 Aug;27(8):953-956. 10.3346/jkms.2012.27.8.953.

Rupture of Right Hepatic Duct into Hydatid Cyst

• Michalopoulos N
• Laskou S
• Papavramidis TS
• Pliakos I
• Kotidis E
• Kesisoglou I
• Papavramidis ST

• KMID: 1714210
• DOI: http://doi.org/10.3346/jkms.2012.27.8.953

Abstract

Echinococcal disease can develop anywhere in the human body. The liver represents its most frequent location. Hepatic hydatid cysts may rupture into the biliary tract, thorax, peritoneum, viscera, digestive tract or skin. We report a rare case with rupture of the right hepatic duct into a hydatid cyst in a woman with known hydatid disease and choledocholithiasis. The increased intra-luminal pressure in the biliary tree caused the rupture into the adjacent hydatid cyst. The creation of the fistula between the right hepatic duct and the hydatid cyst decompressed the biliary tree, decreased the bilirubin levels and offered a temporary resolution of the obstructive jaundice. Rupture of a hydatid cyst into the biliary tree usually leads to biliary colic, cholangitis and jaundice. However, in case of obstructive jaundice due to choledocholithiasis, it is possible that the cyst may rupture by other way around while offering the patient a temporary relief from his symptoms.

Keyword

Hydatid Disease; Cholelithiasis; Echinococcal Cyst Rupture; Cystobiliary Fistula

MeSH Terms

Bilirubin/blood
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy
Choledocholithiasis/complications/diagnosis
Common Bile Duct/surgery
Echinococcosis, Hepatic/complications/*diagnosis/surgery
Female
Gallstones/complications/diagnosis
Hepatic Duct, Common/*surgery
Humans
Jaundice, Obstructive/complications/diagnosis
Middle Aged
Rupture
Tomography, X-Ray Computed
Bilirubin

Figure

• 

  Fig. 1 CT scan images (A, B) showing a huge multi-locular cyst (arrows) adjacent the A B right hepatic bile duct.

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  Fig. 2 MRCP images showing communication between the echinococcal cyst and the right hepatic duct. The common hepatic duct and the common bile duct are full with material of unknown origin. (A) Cholangiopancreatography. (B) Cross-section imgae. (C) Frontal-section A B C image.

• 

  Fig. 3 Intraoperative images (A-D) showing pigmented gallstones removed from the echinococcal cyst.

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