Predictive clinical factors, diagnosis, and management of intrabiliary rupture of a hepatic hydatid cyst in Erbil Teaching Hospitals, Erbil province-North Iraq

ABSTRACT

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