Obstructive jaundice caused by intrabiliary rupture of hydatid cysts

ABSTRACT

Seventeen patients with obstructive jaundice due to intrabiliary rupture of hydatid cysts were surgically treated during a three-year period. The diagnosis, though suspected clinically was confirmed by ultrasonogrophy and established at operation. The principles of management are the surgical treatment of the cyst and drainage of the biliary tree. Endocystectomy and closure of the biliary communication were performed in all cases. The cyst cavity was externally drained in 13 cases [76.5%] and packed with omentum in 4 cases [23.5%]. The common bile duct was drained by a [T] tube in 5 cases [29.4%] by choledochoduodenostomy in 12 cases [70.6%]. Cholecystectomy was performed in 10 cases [58.8%]. Sixteen patients had an uneventual recovery, while one patient died 3 days after surgery because of septicaemia [the mortality rate was 5.9%]. One patient treated by [T] tube drainage of the CBD developed persistent biliary discharge after tube removal, while the other 4 developed recurrent obstructive jaundice within 4 months after surgery. All these patients required further surgery, where choledochoduodenostomy was performed in 3 cases and sphincteroplasty in the other two. In contrast, all survivors treated by choledochoduodenostomy did not develop recurrent biliary obstruction throughout the follow-up period [one year after surgery]. So, we conclude that, although intrabiliary rupture of hydatid cysts of the liver is a life-threatening problem due to the associated obstructive jaundice and cholangitis, it can be efficiently managed by prompt surgical intervention with establishment of permanent biliary drainage by a wide choledochoduodenostomy We also recommend routine cholecystectomy as a part of the operative procedure because of the high incidence of postoperative acute cholecystitis in such cases [5 out of 7; 71.4%, within 6 months after surgery]