Asian Journal of Medical Principles and Clinical Practice

Background: Intrabiliary rupture is a clinically important complication of hepatic hydatid disease and may present with biliary obstruction or cholangitis. This study describes the clinical, radiological, operative, and early postoperative features of patients treated surgically for hepatic hydatid cysts ruptured into the biliary tract.

Methods: A retrospective review was conducted of six patients with hepatic hydatid cysts complicated by biliary communication who were managed in the Department of Digestive Surgery I, Mohammed V Military Teaching Hospital, Rabat, Morocco between March 2017 and September 2020. Data were obtained from medical records and operative reports. Clinical presentation, imaging, laboratory findings, operative management, and postoperative course were analysed descriptively.

Results: Six of 37 patients operated for hepatic hydatid cysts had intrabiliary rupture (16.2%). The mean age was 38 years (range, 18–56), and four patients were women. Right upper quadrant pain was present in 5/6 patients, fever in 3/6, jaundice in 2/6, and cholangitis in 2/6; one case was discovered incidentally. Ultrasonography was performed in all patients, computed tomography in four, and magnetic resonance cholangiographic imaging in two. Biliary dilatation was documented in 2/6 patients. All patients underwent open surgery. Resection of the protruding dome was performed in 4/6 patients, while two patients underwent resection of the protruding dome combined with pericystectomy for multiple cysts. Main bile duct drainage was used in 4/6 patients and a Perdomo transhepatic cystic drainage procedure in 2/6. No deaths were reported. The postoperative stay ranged from 9 to 15 days (mean, 12 days). Postoperative recovery was explicitly reported as uncomplicated in five patients; the postoperative morbidity status of the remaining patient was not specified in the source records.

Conclusion: Intrabiliary rupture of hepatic hydatid cysts showed heterogeneous clinical and imaging presentations in this small retrospective series. Jaundice and biliary dilatation were absent in several patients despite biliary communication. Open surgery with treatment of the cyst, residual cavity, and biliary communication was the management used in this cohort. Larger contemporary series are needed to define optimal diagnostic and therapeutic pathways.