RESUMO
This study investigates the clinical factors associated with an intrabiliary rupture of a hepatic hydatid cyst for early diagnosis and management of cystobiliary communications in patients with liver echinococcosis and presents our experience with this condition. A prospective study included patients with hepatic hydatid cysts treated between years 2000 and 2007 in a single institution, Erbil Teaching hospital Erbil province-Iraq. Database containing 121 patients with a hepatic hydatid cyst were reviewed. The following variables were analyzed as potential predictors of an intrabiliary rupture: age, sex, type, duration of symptoms, findings on physical examination, leukocyte count, liver function test results, serologic test results, suggestive ultrasonographic findings, ltrasonographic cyst features [type, diameter, number, and localization], and whether the cyst is primary or recurrent. Multivariate analysis showed that the independent clinical factors for the presence of an occult rupture were a history of gastric upset in the form of nausea and vomiting [p=0.004], alkaline phosphatase level greater than 140 U/L [p=0.004], total bilirubin level greater than 0.7 mg/dL [>13.5 micro mol/L] [p<0.001], and cyst diameter greater than 14.5 cm [p<0.001] in multivariate analysis. Multivariate analysis also showed that history of jaundice [p<0.001], jaundice found on physical examination [p=0.05], cyst diameter greater than 10.5 cm [p=0.009], a type IV cyst [p<0.001], and suggestive ultrasonographic findings [p<0.001] were the independent clinical predictors for the presence of a frank intrabiliary rupture. Patients with cystobiliary communications had increased morbidity rates to 47.8% of 23 patients vs. 9.9% of 98 patients [p<0.001], and longer mean postoperative hospital stays [11.5 versus 8.4 days; p=0.03] compared with others. Clinical predictors should be considered for early diagnosis and proper management of intrabiliary ruptures in patients with hepatic hydatid cysts, since a frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event, and one should be aware of it in differential diagnosis of obstructive jaundice. Patients with cystobiliary communications had increased morbidity rates