Role of the peritoneopleural pressure gradient in the genesis of hepatic hydrothorax. An isotopic study.

SUMMARY: Hepatic hydrothorax is defined as the development of significant pleural effusion in a patient with cirrhosis without primary pulmonary or cardiac disease. This complication is seen in 4-10% of patients with cirrhosis. The pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm. We report two patients with posthepatitis cirrhosis presenting with a significant pleural effusion. The peritoneopleural communication was demonstrated by peritoneal scintigraphy. The role of the peritoneopleural pressure gradient is discussed.

[Persistent external biliary fistula after surgery for hepatic hydatid cyst]. / Les fistules biliaires externes intarissables après chirurgie de l'hydatidose hépatique.

Post-operative persistent biliary fistulae due to hydatid cysts are difficult to manage. We report 3 cases of external biliary fistulae complicating surgery for hepatic hydatid cyst (2 cases) and intraperitoneal hydatid cyst (1 case). Endoscopic sphincterotomy was successful with closure of the fistulae in all patients. This procedure should be the first-line treatment for post-operative external biliary fistulae related to liver hydatid disease. Usually difficult and haemorrhagic surgery can thus be avoided.