[Budd-chiari syndrome a rare complication of hepatic echinococcosis; about 3 cases]

Hydatid disease is a parasitic infestation due to the development of echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be involved by hydatidosis and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd-Chiari syndrome have rarely been reported. We present herein, three rare cases of hydatid cyst complicated by Budd-Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients and his diameter was 12, 5 cm, 21 cm and 12, 5 cm respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the two others. The Budd-Chiari syndrome was chronic in one patient and asymptomatic in the two others. His diagnosis was established by abdominal US in two cases, completed by US Doppler and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the later case. The Budd-Chiari syndrome was due to compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in one case. Laparotomy was performed in all patients. The surgical procedure consisted in resection of the protruding hepatic tissue after puncture aspiration of the cyst in the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage and by development of ascitis, in one case. Hydatid cyst should be remembered amongst the causes of Budd-Chiari syndrome in countries where the disease is endemic. Conversely, this vascular complication should be looked for routinely in patients with hydatid disease of the liver