Cholecysto-Hydatid Cyst Fistula: A Rare Cause of Cholangitis.

BACKGROUND Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. CASE REPORT A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. CONCLUSIONS We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

[Hydatid cysts of the liver ruptured into the thorax (about five cases)]. / Kystes hydatiques du foie rompus dans le thorax (à propos de cinq cas).

INTRODUCTION: Hydatid cyst of the liver remains a serious public health problem in Tunisia. This benign affection can sometimes cause fatal complications such as cyst rupture into the thorax. CLINICAL CASES: We report 5 cases of patients who experienced intrathoracic rupture of hydatic cyst of liver. There were four rural women and an urban man. Patients were between 60 and 75 years of age. We present 2 cases of cyst rupture into pleura, 3 cases of hydatid bronchial fistula and 3 cases of biliothoracic fistulas. Surgical treatment was performed by laparotomy in 3 cases, thoracic approach in one case and by thoracoabdominal approach in the other case. We deplore one case of early death by hemorrhagic shock. CONCLUSION: Authors emphasize the complexity of the management of hydatic cyst of liver ruptured into the thorax. Surgical treatment remains responsible of high perioperative morbidity and mortality. Early diagnostic and improvement of reanimation measures are important to improve the prognosis of this serious complication.

Sublingual fistula in a masked booby (Sula dactylatra) and possible role of ectoparasites in its etiology.

A sublingual fistula is an opening through the ventral skin of the buccal cavity through which the tongue can protrude. The cause is unknown. Masked Boobies (Sula dactylatra) are the third avian species to be reported with this condition. We argue that ectoparasite infestation of hatchlings may be an initial cause.

[Unusual discovery of omphalomesenteric fistula. A case report]. / Un cas de découverte inhabituelle de fistule omphalo-mésentérique.

Omphalomesenteric fistula is a complete persistence of the omphalomesenteric duct communicating between the umbilicus and the intestine. The presence of intestinal contents suggests the diagnosis in its typical form. We report a case of omphalomesenteric fistula in a 3-year-old boy to show that intestinal parasitic infection associated with ascariasis expulsion through the umbilicus can be the incidental finding of the omphalomesenteric fistula. This case needs no paraclinical investigation and treatment consists in partial transumbilical resection followed by umbilicus restitution.

Cardiac tamponade via a fistula to the pericardium from a hydatid cyst: case report and review of the literature.

Although echinococcus is endemic in many sheep-raising areas of the world, cardiac involvement is rare. Cysts usually reach the heart by means of the coronary circulation, but other routes have been proposed. Pericardial tamponade due to a hydatid cyst has not yet been described in the literature. We present the case of a 46-year-old woman who presented to the Emergency Department with complaints of chest pain and mild dyspnea. Her medical history was positive for a liver hydatid cyst operation 26 years earlier. She was tachypneic, tachycardic, and hypotensive. Pleural and pericardial effusions were detected on transthoracic echocardiography. When she worsened clinically, pericardiocentesis was performed and she promptly improved. A fistula was detected between the liver and pericardium on computed tomography (CT) scan of the torso. Serologic test (agglutination) for Echinococcus granulosus was positive in a 1/32 dilution. A final diagnosis of mediastinal hydatic cyst was made, and a 4-week course of albendazol was given. Then the cyst was surgically excised, and the patient recovered without complications.

Complications of extrahepatic echinococcosis: fistulization of an adrenal hydatid cyst into the intestine.

Echinococcal cysts are usually found in liver and lungs, but any other organ can potentially be involved. Extrahepatic disease due to hydatid cyst may develop in the abdominal and pelvic cavity, aside from in other less common locations, which may make both diagnosis and treatment more complex. We present a rare case of extrahepatic echinococcosis in a 70-year old patient with a 4-d history of dull abdominal pain, anemia within the transfusion range and fever. She underwent surgery for left renal hydatid cysts 30 years ago. After non operative treatment, imaging studies showed a calcified hydatid cyst in a retrogastric location communicating with a proximal jejunal loop. En-block resection of the mass together with the adrenal gland was performed including closure of the enteric fistula. Anatomic pathology confirmed the diagnosis of a calcified hydatid cyst of left adrenal origin. Surgery is the treatment of choice and most authors recommend removal of cyst and adrenal gland.

The usefulness of endoscopic retrograde cholangiopancreatography and (99m)Tc-labeled albumin macroaggregates in diagnosing hydatid disease fistulae.

Hydatid disease is an important health problem in areas where it is endemic. There are several therapeutic modalities, the most important being surgery, antibiotherapy, and percutaneous treatment. In recent years percutaneous treatment has become popular, and for this method or surgery it is sometimes lifesaving to know the relation between the biliary ducts and the cyst cavity. The aim of this study was to examine the usefulness of endoscopic retrograde cholangiopancreatography and (99m)Tc-labeled albumin macroaggregates in diagnosing hydatid disease fistulae before percutaneous or surgical treatment. A total of 72 patients diagnosed with hepatic hydatid disease via ultrasound and serologic tests were enrolled in the study. Endoscopic retrograde cholangiopancreatography was successfully performed in all patients. (99m)Tc-labeled albumin macroaggregates also were injected into cysts at a dose of 1.5-2 mCi just before the treatment. All but three patients were treated percutaneously. Scintigraphy of abdominal and thoracic areas was performed with a GE Starcam 3200 XC/T gamma camera at 30 and 120 min after Tc-labeled albumin macroaggregate injections. Endoscopic retrograde cholangiopancreatography revealed communications between biliary ducts and cyst cavities in nine patients (12.5%). However, (99m)Tc-labeled albumin macroaggregates showed not only leakage into the systemic circulation in nine patients but also into the biliary ducts in two (15.4%). In one patient, mild acute pancreatitis occurred as a complication of endoscopic retrograde cholangiopancreatography. No complications of (99m)Tc-labeled albumin macroaggregates injection were seen. Three patients were surgically treated because of clinically manifested cystobiliary fistulae. We conclude that endoscopic retrograde cholangiopancreatography is a gold standard technique for the diagnosis of communication between the biliary duct and the cyst cavity, and (99m)Tc-labeled albumin macroaggregate injection is useful for revealing leakage into the systemic circulation. The diagnosis of biliary fistulae before percutaneous treatment of hydatid disease may enable planning of the optimal therapy.

[Broncho-splenic fistula caused by hydatidosis]. / Fistula bronco-esplénica devida a hidatidose.

To our knowledge, this is the first case report of a broncho-splenic fistula of hydatid origin. We discuss the clinical, radiological and therapeutic aspects of this rare complication of hydatid disease.

[Hydatidosis of the humerus complicated with fracture, bacterial infection, fistula, and extraosseous localization]. / Hidatidosis del húmero complicada con fractura, infección bacteriana, fístula y localización extraósea.

The clinical case of an apparently healthy 63-year-old man from a rural area, with previous contact with dogs, who had a pathological fracture of the right humerus is presented. Initially he presented slight local pain, and functional discapacity. Eight months later, after a radiological study and surgery (curettage), diagnosis of hydatid disease was made. Later on, after receiving two courses with albendazole, the parent continued in similar conditions for seven years, when his situation became complicated with bacterial, fistula and extraoseous hydatidosis. The humerus was resected and a segmentary prothesis was successfully set.