|
1
|
Gümüşoğlu AY, Kabuli HA, Değerli MS, Atar B, Köneş O, Kocataş A, Bingül ND, Dolay K. Endoscopic definitive treatment of liver hydatid cysts ruptured into bile duct. Surg Endosc 2024:10.1007/s00464-024-11305-9. [PMID: 39367134 DOI: 10.1007/s00464-024-11305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 09/22/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Intrabiliary rupture (IBR) is one of the most common complications of hepatic hydatid cysts (HHC),and the surgical treatment of major intrabiliary rupture (MIBR) leads to serious morbidity and mortality. This study aimed to evaluate the efficacy of endoscopic definitive treatment of these patients. METHODS This study included 38 patients who underwent ERCP for MIBR between 2004 and 2022. Endoscopic sphincterotomy (ES) was performed, followed by evacuation of hydatid contents from the main bile ducts and cyst cavity. A nasobiliary drainage (NBD) catheter was placed inside the cyst cavity in 15 patients, while biliary stenting (BS) was performed in 23 patients. Demographic data, cyst characteristics, hospital stay, complications, treatment success, and recurrence were analyzed. RESULTS The mean age of patients was 46.5 years, with 12 female and 26 male. All patients had WHO-type-3B hydatid cysts with an average diameter of 7.9 cm. NBD was continued for definitive purposes in 13 of the 15 patients who underwent NBD, and full cure was achieved in 13 patients. Among the 23 patients who underwent biliary stenting (BS), 16 (69.5%) required a second ERCP due to jaundice or cholangitis, and 6 (26%) underwent percutaneous drainage due to hydatid cavity infection. The average length of hospital stay was 16.13 days in the BS group, while it was 8.3 days in the NBD group.The average follow-up period was 23 months. All patients achieved complete recovery. CONCLUSIONS The endoscopic approach is an effective and safe method for the treatment of MIBR, and can be considered as a definitive treatment option in centers with adequate resources and experienced endoscopists.
Collapse
Affiliation(s)
- Alpen Yahya Gümüşoğlu
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hamit Ahmet Kabuli
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Said Değerli
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burak Atar
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Osman Köneş
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocataş
- Department of General Surgery, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Nilsu Damla Bingül
- Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kemal Dolay
- Department of General Surgery and Intestinal Endoscopy, Dolay Clinic, Istanbul, Turkey.
- Hakkı Yeten Caddesi, Aşçıoğlu Plaza:17 Beşiktaş, 34349, İstanbul, Turkey.
| |
Collapse
|
|
2
|
Manterola C, Rivadeneira J, Rojas-Pincheira C, Otzen T, Delgado H, Sotelo C, Sanhueza A. Cholangiohydatidosis. Clinical features, postoperative complications and hospital mortality. A systematic review. PLoS Negl Trop Dis 2024; 18:e0011558. [PMID: 38452054 PMCID: PMC10950226 DOI: 10.1371/journal.pntd.0011558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/19/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Cholangiohydatidosis (CH) is an evolutionary complication of hepatic cystic echinococcosis, associated with increased morbidity and mortality. The aim of this study was to describe the available evidence regarding clinical characteristics of CH, postoperative complications and hospital mortality. METHODOLOGY/PRINCIPAL FINDINGS Systematic review. Studies related to CH with no language or publication restriction were included. Sensitive searches were performed in Trip Database, SciELO, BIREME-BVS, WoS, PubMed, EMBASE and SCOPUS. MeSH and free terms were used, including articles up to April 2023. The main outcome variables were postoperative complications and hospital mortality; the secondary ones were publication year, origin and design of primary studies, main clinical manifestation, anatomical location and type of cysts, hospital stay, surgical procedure performed, reinterventions; and methodological quality of primary studies, which was assessed using MInCir-T and MInCir-P scales. Descriptive statistics, calculation of weighted averages and their comparison by least squares logistic regression were applied. 446 studies were retrieved from the searches performed, 102 of which met the inclusion and exclusion criteria. The studies analyzed represent 1241 patients. The highest proportion of articles was published in the last decade (39.2%). Reports are mainly from Turkey (28.4%), Greece (9.8%), Morocco and Spain (8.8% each). With a weighted mean of 14.3 days of hospital stance; it was verified that 26.2% of patients developed postoperative complications (74,3% Clavien y Dindo III y IV), 6.7% needed re-interventions, and 3.7% died. When comparing the variables age, postoperative complications, hospital mortality, and reinterventions in two periods of time (1982-2006 vs. 2007-2023), no statistically significant differences were found. When applying the MInCir-T and MInCir-P scales, the methodological quality of the primary studies was 9.6±1.1 and 14.5±4.3 points, respectively. CONCLUSION/SIGNIFICANCE CH is associated with severe postoperative complications and significant hospital mortality, independent of the development of therapeutic support associated with the passage of time.
Collapse
Affiliation(s)
- Carlos Manterola
- Center for Morphological and Surgical Studies. Universidad de La Frontera. Chile
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
| | - Josue Rivadeneira
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
- Zero Biomedical Research. Quito, Ecuador
| | - Claudio Rojas-Pincheira
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
| | - Tamara Otzen
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
- Núcleo Milenio de Sociomedicina. Santiago, Chile
| | - Hugo Delgado
- PhD. Program in Medical Science, Universidad de La Frontera, Chile
| | | | - Antonio Sanhueza
- Pan American Health Organization, Washington, United States of America
| |
Collapse
|
|
3
|
Jiang T, Wang Z, Aji T, Ran B, Guo Q, Zhang R, Tuergan T, Zhong K, Shao Y, Hao W. ERCP management of acute cholangitis caused by rupture of Echinococcus hepaticus into the biliary tract. J Minim Access Surg 2023; 19:498-503. [PMID: 37282433 PMCID: PMC10695320 DOI: 10.4103/jmas.jmas_219_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/24/2022] [Accepted: 02/09/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Hepatic cystic echinococcosis (HCE) rupture into the biliary tract, one of the most common and refractory complications, is treated by laparotomy to remove hydatid lesions. The aim of this article was to investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of this particular disease. PATIENTS AND METHODS This was is a retrospective analysis of 40 patients with HCE ruptured into the biliary tract in our hospital from September 2014 to October 2019. They were divided into two groups, ERCP group (group A, n = 14) and conventional surgery group (group B, n = 26). Group A was treated with ERCP first to control infection and improve the general condition before undergoing laparotomy at an optional stage while group B was treated with laparotomy directly. First, the infection parameters and liver, kidney and coagulation functions of group A patients before and after ERCP were compared to evaluate treatment effectiveness. Second, the intraoperative and post-operative parameters during the laparotomy of group A were compared with group B to evaluate the impact of ERCP treatment on laparotomy. RESULTS AND CONCLUSIONS White blood cell, NE%, platelet, procalcitonin, C-reactive protein, interleukin-6, Total bilirubin (TBIL), alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate transaminase, alanine transaminase (ALT), ALT and Cr in group A significantly improved by ERCP (P < 0.05); during laparotomy, the bleeding amount and hospital stay in group A were better (P < 0.05); moreover, concerning the post-operative complications, the incidence of acute renal failure and coagulation dysfunction in group A was significantly less (P < 0.05). ERCP, which not only quickly and effectively controls infection and improves the patient's systemic condition but also provides good support for subsequent radical surgery, enjoys good prospects for clinical application.
Collapse
Affiliation(s)
- Tiemin Jiang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zongding Wang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary Surgery, Fengjie County People’s Hospital of Chongqing, 404600, P. R. China
| | - Tuerganaili Aji
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bo Ran
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Guo
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ruiqing Zhang
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kai Zhong
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yingmei Shao
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wen Hao
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| |
Collapse
|
|
4
|
Bayrak M, Altıntas Y. Current approaches in the surgical treatment of liver hydatid disease: single center experience. BMC Surg 2019; 19:95. [PMID: 31315619 PMCID: PMC6637587 DOI: 10.1186/s12893-019-0553-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Background Liver hydatid disease is a common benign condition in many countries. Compared to open surgery, laparoscopic treatment can play an important role in improving the post-operative recovery, reducing the morbidity and recurrence rate of these patients.The purpose of this study is to show that the laparoscopic method is effective and safe in the treatment of liver hydatid cysts compared to open surgery, even in large cysts. Methods All consecutive cases surgically managed for liver hydatid cyst from 7 January 2008 and 15 January 2010 in our institution were included in this study.The surgical approach (laparoscopic or open) and operative strategy, as well as operative and prognostic outcomes, were analyzed. Cyst size, type, location, presence of biliary tract communication, radiological findings, duration of hospitalization, recurrence and postoperative morbidity were analysed and compared retrospectively. Results A total of 60 patients were included in the study.A total of 23 patients underwent open surgery, and 37 patients underwent laparoscopic surgery.Operation types of laparoscopic surgery were as follows: partial pericystectomy (12patients), total cystectomy(2 patients), partial pericystectomy+total cystectomy(7patients) and cystectomy(16patients).The surgical procedures chosen for open treatment of the residual cavity were partial pericystectomy and omentoplasty(17cases), total pericystectomy(3cases) and partial and total pericystectomy(3cases).Cysto-biliary communication was found in 9 patients. A total of 10 patients underwent preoperative endoscopic retrograde cholangiography, and one patient underwent postoperative endoscopic retrograde cholangiography.There was a progression of hypernatremia in 1 patient, wound infections in 3 patients, and perioperative hemorrhage in 3 patients. There were no statistically significant differences concerning age(p = 0.344), gender(p = 0.318), ASA classification(p = 0.963), Gharbi classification(p = 0.649) whereas there were significant differences related to cyst location(p = 0.040) and size(p = 0.022) in patients undergoing laparoscopic and open surgery. Postoperative temporary biliary fistulas were observed in 2 patients undergoing open surgery. Patients undergoing laparoscopic surgery had the advantages of shorter hospital stays and operation times, less blood loss, faster recovery, and lower wound infection rates. Recurrences were detected in 2.7% of patients undergoing laparoscopic surgery and 4.7% of those undergoing open procedures. Conclusion Compared to open surgery in the treatment of liver hydatid cysts, we have shown that laparoscopic method can be safely performed even in large cysts and/or cysto-biliary communication.
Collapse
Affiliation(s)
- Mehmet Bayrak
- Department of General Surgery , Ozel Ortadogu Hospital, Ziyapasa Mahallesi 67055 Sokak no:1, Adana, Turkey.
| | - Yasemin Altıntas
- Department of Radiology , Ozel Ortadogu Hospital, 01360, Adana, Turkey
| |
Collapse
|
|
5
|
Robbani I, Shah OJ, Shah AA, Ilyas M. Dual Parasitization of the Biliary Tree: First Reported Case. ACG Case Rep J 2019; 6:e00082. [PMID: 31616753 PMCID: PMC6658062 DOI: 10.14309/crj.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/27/2019] [Indexed: 11/17/2022] Open
Abstract
Cases of biliary ascariasis and hydatid cysts in liver and elsewhere are common in endemic areas and are routinely encountered in surgical outpatient departments. We describe the diagnosis and management of a unique case, who presented with manifestations of biliary ascariasis, but on further investigation was found to harbor ascarids as well as ruptured hydatids in his biliary passages. To our knowledge, this is the first reported case of simultaneous parasitization of common bile duct by ascarid and hydatid forms, resulting in obstruction of the biliary system. This report highlights the diversity of presentation and challenges in the management of such cases, when encountered in practice.
Collapse
Affiliation(s)
- Irfan Robbani
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Omar Javed Shah
- Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Altaf A Shah
- Department of Medical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mohd Ilyas
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| |
Collapse
|
|
6
|
Reddy DN, Rao GV, Banerjee R. Tropical Parasitic Infestations. ERCP 2019:464-468.e2. [DOI: 10.1016/b978-0-323-48109-0.00049-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
7
|
|
|
8
|
Pinto P, Gaete S, Vega P. Utilidad de la CPRE en el diagnóstico y manejo de las complicaciones biliares de la enfermedad hidatídica hepática. REVISTA CHILENA DE CIRUGÍA 2016; 68:283-288. [DOI: 10.1016/j.rchic.2016.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
9
|
Borahma M, Afifi R, Benelbarhdadi I, Ajana FZ, Essamri W, Essaid A. Endoscopic retrograde cholangiopancreatography in ruptured liver hydatid cyst. Indian J Gastroenterol 2015; 34:330-334. [PMID: 26345677 DOI: 10.1007/s12664-015-0585-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/05/2015] [Indexed: 02/04/2023]
Abstract
One of the most common and serious complications of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistula is associated with high morbidity and mortality. We retrospectively reviewed the effectiveness of endoscopic treatment of ruptured hydatid cyst into intrahepatic bile ducts. Diagnosis of intrabiliary rupture of hydatid cyst was mostly suspected by acute cholangitis, jaundice, pain, and/or persistent external biliary fistula after surgery. The diagnosis was confirmed by radiology and endoscopic retrograde cholangiopancreatography (ERCP) findings. We retrospectively reviewed clinical, laboratory, imagery, and ERCP findings for all patients. The therapeutic methods performed were endoscopic sphincterotomy, extraction by balloon or Dormia basket, stenting, or nasobiliary drainage. Sixteen patients with ruptured hepatic hydatid cyst into bile ducts were seen in 9 years. Nine of 16 patients had a surgical history of hepatic hydatid cyst and three patients had a percutanous treatment history. We carried out ERCP with sphincterotomy and extraction of hydatid materials (extraction balloon n = 11; Dormia basket n = 5) or biliary drainage (nasobiliary drainage n = 1; biliary stenting n = 1). The fistula healed in 80 % of patients with a median time of 6 weeks [range, 1-12] after endoscopic treatment. ERCP was an effective method of treatment for hepatic hydatid cyst with biliary fistula.
Collapse
Affiliation(s)
- Mohamed Borahma
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco.
| | - Rajaa Afifi
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Imane Benelbarhdadi
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Fatima Zahra Ajana
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Wafaa Essamri
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| | - Abdellah Essaid
- Department of Gastroenterology C, Ibn Sina Hospital, University Mohammed Vth, Rabat, Morocco
| |
Collapse
|
|
10
|
Dolay K, Akbulut S. Role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease. World J Gastroenterol 2014; 20:15253-15261. [PMID: 25386073 PMCID: PMC4223258 DOI: 10.3748/wjg.v20.i41.15253] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/30/2014] [Accepted: 06/12/2014] [Indexed: 02/06/2023] Open
Abstract
Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management. However, the diagnosis and management of complicated hepatic hydatid disease is a special issue. One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts. The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice, cholecystitis, cholangitis, liver abscess, pancreatitis and septicemia. Current treatments for major ruptures can result in high morbidity and mortality rates. Furthermore, ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae, biloma, cavitary infection and obstructive jaundice. In the past, these complications were diagnosed and treated by surgical methods. Currently, complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods. In clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts, or for biliary adverse events after surgery, including persistent biliary fistulae and jaundice. However, controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains. In this article, the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.
Collapse
|
|
11
|
Akaydin M, Erozgen F, Ersoy YE, Birol S, Kaplan R. Treatment of hepatic hydatid disease complications using endoscopic retrograde cholangiopancreatography procedures. Can J Surg 2012; 55:244-8. [PMID: 22617539 DOI: 10.1503/cjs.036010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Liver hydatidosis may lead to serious morbidity due to biliary complications, the management for which endoscopic sphincterotomy (ES) and biliary drainage are very efficient. We evaluated the effectiveness of endoscopic treatment for complications of hepatic hydatid disease. METHODS We retrospectively reviewed endoscopic retrograde cholangiopancreatography (ERCP) procedures performed between January 2000 and December 2009 and compared laboratory findings, localization of the lesions and ERCP procedures applied between patients with and without jaundice. RESULTS In all, 70 ERCP procedures were performed in 54 patients (24 men, 30 women). Of the 70 procedures, 24 were performed to treat jaundice. All patients with biliary fistulas and jaundice were managed with endoscopic procedures. The 70 ERCP procedures included sphincterotomy only (n = 40); sphincterotomy and stent placement (n = 7); stent placement only (n = 4); sphincterotomy and membrane extraction (n = 9); sphincterotomy, membrane extraction and pus drainage (n = 5); and sphincterotomy and pus drainage (n = 5). Laboratory results improved in 3-7 days, and bile leakage ceased in 2-21 days. CONCLUSION Endoscopic retrograde cholangiopancreatography is a safe and effective way to manage biliary complications of hepatic echinococcal disease. In most patients, ES is the most efficient treatment of postoperative external biliary fistulas, jaundice and accompanying cholangitis, as it enables clearing the bile ducts of hydatid remnants; ES should be performed since it accelerates the healing process by decreasing pressure in the choledochus.
Collapse
Affiliation(s)
- Murat Akaydin
- Taksim Training and Research Hospital, General Surgery Clinic, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
|
12
|
Biliary obstruction and a mass lesion in the liver: intrabiliary rupture of hepatic hydatid cyst. J Clin Exp Hepatol 2011; 1:125-7. [PMID: 25755328 PMCID: PMC3940105 DOI: 10.1016/s0973-6883(11)60137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
|
13
|
Wani I, Bhat Y, Khan N, Mir F, Nanda S, Shah OJ. Concomitant Rupture of Hydatid Cyst of Liver in Hepatic Duct and Gallbladder: Case Report. Gastroenterology Res 2010; 3:175-179. [PMID: 27942301 PMCID: PMC5139739 DOI: 10.4021/gr215e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2010] [Indexed: 01/04/2023] Open
Abstract
Hydatid cyst liver rupture into the biliary tree may involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts or rarely the gallbladder. Rupture can be occult or frank. A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event. The authors are reporting a case of concomitant rupture of hydatid cyst of liver into right hepatic duct and the gallbladder. A 50-year-old female patient who presented with acute cholangitis was confirmed as a case of intrabilary rupture on ultrasonography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. Rupture of hydatid cyst of liver in right hepatic and the gallbladder was confirmed on surgery. Suture repair of cystobiliary fistula, choledochoduodenostomy with cholecystectomy was done.
Collapse
Affiliation(s)
- Imtiaz Wani
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Younis Bhat
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Naveed Khan
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Farooq Mir
- Department of Radiodiagnosis, SKIMS Srinagar, Kashmir, India
| | - Saima Nanda
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Omar J Shah
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| |
Collapse
|
|
14
|
Ezzat RF, Karboli TA, Kasnazani KA, Hamawandi AM. Endoscopic management of biliary fascioliasis: a case report. J Med Case Rep 2010; 4:83. [PMID: 20205932 PMCID: PMC2841078 DOI: 10.1186/1752-1947-4-83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 03/06/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation. CASE PRESENTATION A 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. CONCLUSION Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.
Collapse
Affiliation(s)
- Rajan F Ezzat
- Kurdistan Gastrointestinal Center, Sulaimanyah Teaching Hospital, Sulaimanyah, Iraq.
| | | | | | | |
Collapse
|
|
15
|
Khoshbaten M, Farhang S, Hajavi N. Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. Dig Endosc 2009; 21:277-9. [PMID: 19961531 DOI: 10.1111/j.1443-1661.2009.00907.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The most common complication of hydatid cysts of the liver is cholestasis due to rupture of hepatic cysts into the biliary tree. Such a complicated cyst is usually managed by surgical cyst resection. Endoscopic retrograde cholangiogram with sphincterotomy is a well-established method for preoperative and postoperative extraction of cyst material from the biliary tree. Successful nonsurgical treatments of complicated hydatid cyst are reported with a combination of pharmaceutical therapy and endoscopic techniques consisting of endoscopic sphincterotomy and instillation of hypertonic saline solutions. We report feasibility and outcome of the endoscopic method for treatment of ruptured hepatic hydatid cyst into the biliary tract that also benefited from drainage of the whole cyst and membranes into the major biliary duct.
Collapse
Affiliation(s)
- Manouchehr Khoshbaten
- Liver and Gastrointestinal Diseases Research Centre, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, East Azerbaijan, Iran
| | | | | |
Collapse
|
|
16
|
Kilic M, Yoldas O, Koc M, Keskek M, Karakose N, Ertan T, Gocmen E, Tez M. Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter? Am J Surg 2008; 196:732-735. [PMID: 18513700 DOI: 10.1016/j.amjsurg.2007.07.034] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 07/10/2007] [Accepted: 07/10/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to determine if there is any predictive factor indicating the risk of bile leakage before surgery for hepatic hydatid disease in clinically asymptomatic patients. METHODS The data of 116 patients who underwent surgery for hepatic hydatid disease were reviewed retrospectively. There were 43 men (37%) and 73 women (63%) with a mean age of 45 +/- 15 years. Because of high preoperative serum bilirubin and liver function test levels, 12 patients were excluded from the study. These patients underwent preoperative endoscopic retrograde cholangiopancreatography. In addition, 2 medically treated patients were excluded from the study. The following variables were analyzed as potential predictors of biliary-cyst communication: age, sex, physical examination findings, leukocyte count, liver function test results, and ultrasonographic cyst features (type, diameter, number, and localization). RESULTS Bile leakage was detected in 24 out of 102 patients. There were no differences in age, sex, cyst type, alkaline phosphatase level, gamma-glutamyl transpeptidase level, alanine aminotransferase level, aspartate aminotransferase level, bilirubin level, and number of cysts and cyst locations between the patients with and without bile leakage. The mean cyst size in patients with biliary leakage was 10.2 cm as compared with 6.1 cm in patients with no biliary leakage (P < .05). When the cut-off value of cyst diameter was accepted as 7.5 cm, the specificity and sensitivity for biliary-cyst communication were 73% and 79%, respectively. CONCLUSIONS These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.
Collapse
Affiliation(s)
- Mehmet Kilic
- Fifth Department of Surgery, Ankara Numune Training and Research Hospital, Cagri Sokak 26/4, Aydinlikevler/Ankara, 06130, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Goumas K, Poulou A, Dandakis D, Tyrmpas I, Georgouli A, Sgourakis G, Soutos D, Karaliotas K. Role of endoscopic intervention in biliary complications of hepatic hydatid cyst disease. Scand J Gastroenterol 2007; 42:1113-9. [PMID: 17710679 DOI: 10.1080/00365520701234318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Biliary complications of hepatic hydatidosis are often difficult to detect and manage. The aim of this study was to present our experience on the effectiveness of endoscopic treatment modalities in cases of biliary complications of hepatic hydatid cysts. MATERIAL AND METHODS Over the past 10 years, 15 patients diagnosed with hepatic hydatidosis and manifesting symptoms and signs indicative of biliary involvement were examined by means of endoscopic retrograde cholangiopancreatography (ERCP) in our Gastroenterology Endoscopic Unit; 7 patients had already been operated on for hepatic hydatid cysts; one of them had a concomitant hydatid cyst in the lung. Diagnosis of the disease was based on a combination of ultrasonography (US), computed tomography (CT) and specific immunologic and/or microbiologic studies. RESULTS Biliary complications of hydatid cysts were detected by ERCP in 9 patients (60%). Eight (88.9%) patients displayed a communication between the hydatid cyst or its residual cavity and the biliary tree; 5 patients had daughter cysts or residual hydatid material within the biliary tree, 1 patient had a biliocutaneous fistula, 1 patient a postoperative biliary leakage and 1 patient had only an opacification of the hydatid cyst during ERCP. In one patient, ERCP showed stenoses of both of the main hepatic ducts due to their compression by the cyst. Jaundice (88.9%), fever (33.3%) and right upper quadrant abdominal pain (88.9%) were the most frequent manifestations. These complications were demonstrated by US and CT imaging in only 25% of the cases. Four patients underwent ERCP before surgery and 5 after surgery. Endoscopic management was successful in all patients, resulting in clearance of the biliary tree, closure of fistulas, stopping of biliary leakage and jaundice remission. No serious endoscopy-related complications were recorded, with the exception of a pulmonary hydatid cyst rupture during ERCP. CONCLUSIONS This study suggests that endoscopic treatment modalities are helpful and safe methods in the treatment of biliary complications of hepatic hydatidosis before and after definitive surgical management of the hydatid cysts.
Collapse
|
|
18
|
Manouras A, Genetzakis M, Antonakis PT, Lagoudianakis E, Pattas M, Papadima A, Giannopoulos P, Menenakos E. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:249-53. [PMID: 17431515 PMCID: PMC2657701 DOI: 10.1155/2007/410308] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas. Endoscopic retrograde cholangiography with sphincterotomy has been successful as the sole and definitive means of treatment of intrabiliary ruptured hydatid cysts. A case of an elderly woman with frank rupture is presented, where the rupture was definitively managed endoscopically in conjunction with sphincterotomy to remove the intrabiliary obstructive daughter cysts and to achieve decontamination of the biliary tree. Endoscopic retrograde cholangiography provided an excellent diagnostic and therapeutic modality in the present case and, thus, it should be considered as definitive treatment in similar cases especially if surgical risk is anticipated to be high.
Collapse
Affiliation(s)
- Andreas Manouras
- First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
|
19
|
Cicek B, Parlak E, Disibeyaz S, Oguz D, Cengiz C, Sahin B. Endoscopic therapy of hepatic hydatid cyst disease in preoperative and postoperative settings. Dig Dis Sci 2007; 52:931-5. [PMID: 17333353 DOI: 10.1007/s10620-006-9426-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 05/01/2006] [Indexed: 02/08/2023]
Abstract
The most common and serious complication of hepatic hydatid cyst disease is the communication between the cyst and the biliary tree. The diagnosis and treatment of this condition poses various difficulties. Data from patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for hydatid cysts communicating with the bile ducts either in the preoperative or postoperative setting over a 2-year period have been analyzed. In the preoperative group (n=41), jaundice (n=18), biliary colic (n=11), and cholangitis (n=10) were the most common presentations. On the other hand, the most common indication for ERCP in the postoperative group (n=69) was biliocutaneous leaks (n=60) and cholangitis (n=9). All but 2 patients in the preoperative group were treated by endoscopic sphincterotomy and/or extraction of hydatid cyst remnants followed by the placement of nasobiliary drainage catheter for the patients who had filling defects on cholangiogram. Subsequently, these patients were referred for surgery. ERCP was a definitive treatment for the remaining 2 patients. Endotherapy was successful for the patients who developed leak or had cyst remnants following surgery, whereas long-term biliary stenting was required for those who developed bile duct stenosis. There was no ERCP-associated complication, except mild pancreatitis in a single patient and self-limited hemorrhage in 2 patients. ERCP is an efficacious and safe method for the diagnosis and management of biliary complications associated with hydatid cyst disease.
Collapse
Affiliation(s)
- Bahattin Cicek
- Department of Gastroenterology, Yuksek Ihtisas Hospital, Sihhiye, Ankara 06100, Turkey
| | | | | | | | | | | |
Collapse
|
|
20
|
Pavlidis TE, Katsinelos PT, Tsiaousis PZ, Atmatzidis KS. Intrabiliary rupture of a large liver echinococcal cyst in an adolescent managed with endoscopic sphincterotomy and albendazole. J Laparoendosc Adv Surg Tech A 2006; 16:493-496. [PMID: 17004876 DOI: 10.1089/lap.2006.16.493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We report the case of a 17-year-old male with a rupture into the biliary tract. The patient was urgently admitted to the surgical department with the clinical diagnosis of cholangitis. Modern imaging techniques and specific serologic tests established the diagnosis of intrabiliary rupture of a liver hydatid cyst due to E. granulosus. Despite the fact that surgery remains the cornerstone of treatment, conservative management was preferred, due to the location of the echinococcal cyst in the right lobe of the liver adjacent to the inferior vena cava and the age of the patient. Endoscopic sphincterotomy was performed with subsequent evacuation of the biliary tree, followed by a sixcycle treatment with albendazole. At one-year follow-up, the patient is in good health, with no radiologic or serologic evidence of relapse.
Collapse
Affiliation(s)
- Theodoros E Pavlidis
- Second Surgical Department, Endoscopy Unit, Aristotle University of Thessaloniki, G Gennimatas Hospital, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
|
21
|
Ozaslan E. Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease. World J Gastroenterol 2006; 12:4930-1. [PMID: 16937486 PMCID: PMC4087638 DOI: 10.3748/wjg.v12.i30.4930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.
Collapse
|
|
22
|
Abstract
BACKGROUND/AIM Intrabiliary rupture of hepatic hydatid cyst causes serious morbidity and mortality. These patients are usually managed surgically. We evaluated the feasibility and outcome of an alternative method of treatment of these patients. METHODS Seven patients with ruptured hepatic hydatid into the biliary tract underwent endoscopic treatment consisting of endoscopic sphincterotomy, cyst material extraction and hypertonic saline lavage via nasocystic catheter. RESULTS Median age of patients was 40 years (range 17-50 years) with a male:female ratio of 2:5. Abdominal pain, jaundice and fever were seen in all patients. Six out of seven patients were positive for hydatid serology. All patients were successfully treated by endoscopic sphincterotomy, clearance of cyst material and hypertonic saline lavage. On a follow-up of 6 months to 4 years (median, 3.5 years), ultrasonography, computed tomography of the abdomen and magnetic resonance imaging of the abdomen showed a complete cure. There were no complications related to procedure. CONCLUSIONS This study demonstrates endoscopic treatment as one of the therapeutic options of ruptured hepatic hydatid cyst into the biliary tract.
Collapse
Affiliation(s)
- Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | | | | | | |
Collapse
|
|
23
|
Klingler PJ, Gadenstätter M, Schmid T, Bodner E, Schwelberger HG. Treatment of hepatic cysts in the era of laparoscopic surgery. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02735.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
|
24
|
Abstract
Hydatid cyst of the liver is a parasitic disease caused by Echinococcus granulosus. The principal complications are infection, biliary duct fistula, and rupture into the peritoneum or chest. Diagnosis has become easier with advances in ultrasonic imaging and CT scanning. Surgery remains the most effective treatment but postoperative complications arise in 30% of cases, particularly when the surgical approach is conservative. Radical surgical approaches give better results and should be used in most cases. Biliocutaneous fistula and infection of the residual cavity are the most common postoperative complications and result in prolonged hospitalization and excess costs. New therapeutic strategies incorporate endoscopic, percutaneous, and medical therapies with surgery and have allowed an improvement in morbidity and mortality due to hydatid cysts of the liver. Until immunization becomes a possibility, preventive measures are necessary to avoid disease recurrence.
Collapse
Affiliation(s)
- J Sakhri
- Service de chirurgie générale et digestive, Unité de recherche en chirurgie UR/17/02, CHU Farhat Hached, 24 Avenue Haffouze, 4000 Sousse, Tunisia.
| | | |
Collapse
|
|
25
|
Reddy DN, Sriram PVJ, Rao GV. Endoscopic diagnosis and management of tropical parasitic infestations. Gastrointest Endosc Clin N Am 2003; 13:765-73, x-xi. [PMID: 14986797 DOI: 10.1016/s1052-5157(03)00072-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Biliary parasitosis is one of the common causes of biliary obstruction in developing countries and can often be confused with stone disease. With increased worldwide travel and immigration, these conditions are not limited to the developing countries alone. Ascariasis, hydatid liver disease, clonorchiasis, and fascioliasis are the commonly encountered parasitic infestations of the biliary tract usually presenting with biliary colic or cholangitis. Endoscopy has an important role in the diagnosis and emergent management of these conditions and in elective endoscopic therapy of associated complications. Endoscopic sphincterotomy and bile ductal clearance, along with pharmacotherapy, are the mainstays of treatment.
Collapse
|
|
26
|
Simşek H, Ozaslan E, Sayek I, Savaş C, Abbasoğlu O, Soylu AR, Balaban Y, Tatar G. Diagnostic and therapeutic ERCP in hepatic hydatid disease. Gastrointest Endosc 2003; 58:384-389. [PMID: 14528213 DOI: 10.1067/s0016-5107(03)00013-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND This retrospective study evaluated the use of diagnostic and therapeutic ERCP in pre- and postoperative patients with hepatic hydatid disease. METHODS For 8 years, ERCP was performed in 39 patients with hepatic echinococcal disease. Indications in the preoperative group of patients (n = 19) included a cholestatic enzyme profile in all cases; jaundice or acute cholangitis also was present in, respectively, 14 and 7 cases. In the postoperative group (n = 20), indications for ERCP included persistent external biliary fistula after surgery in 10 patients, jaundice in 8, acute cholangitis in 7, and right upper quadrant pain in 2 patients. RESULTS ERCP findings in the preoperative group included cystobiliary fistula (9 patients), external compression of the hepatic biliary system (5), hydatid vesicles and/or membranes within the biliary tract (3), intrahepatic duct stricture (1), and a normal cholangiogram (4). The most common ERCP finding in the postoperative group was external biliary fistula (10 patients); other findings consisted of hydatid cyst material within the bile duct (4), bile duct stenosis (2), cystobiliary fistula and hydatid cyst material in the bile duct (1), cystobiliary fistula (1), hydatid membranes in the gallbladder (1), extrinsic compression to bile ducts (1), and a normal cholangiogram (1). In the preoperative group, endoscopic sphincterotomy was performed in 11 patients, with balloon catheter extraction in 2; complete resolution of findings was achieved in 10 cases. In the postoperative group, sphincterotomy (with balloon or basket extraction as needed) was performed in 19 patients, stents were placed in 2 patients, 1 patient underwent balloon dilatation, and 1 had nasobiliary drainage; there was complete resolution of the findings in 14 of the 20 patients. CONCLUSIONS ERCP and related therapeutic maneuvers are safe and valuable in the pre- and postoperative management of patients with hepatic hydatid disease.
Collapse
Affiliation(s)
- Halis Simşek
- Department of Internal Medicine, Division of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Bilsel Y, Bulut T, Yamaner S, Buyukuncu Y, Bugra D, Akyuz A, Sokucu N. ERCP in the diagnosis and management of complications after surgery for hepatic echinococcosis. Gastrointest Endosc 2003; 57:210-3. [PMID: 12556786 DOI: 10.1067/mge.2003.64] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgery for liver hydatidosis can result in serious morbidity and mortality. The role and efficacy of ERCP in the management of these complications was reviewed. METHODS Retrospective analysis of 79 patients with liver hydatidosis who underwent ERCP for postoperative complications. RESULTS All patients with biliary fistulas (n = 50) were managed by endoscopic sphincterotomy, although 9 (18%) also required a biliary endoprosthesis. Surgical reintervention was avoided in 46 (92%) patients with subsequent surgery required in only in 4 (8%). The mean time to fistula closure was 13.3 days. Patients with daughter cysts in the bile ducts (n = 7) were also treated by endoscopic sphincterotomy and evacuation of obstructing cyst material. Seven patients with elevated liver enzymes or biliopancreatic symptoms but normal ERCP findings also underwent endoscopic sphincterotomy with normalization of biochemical tests. CONCLUSIONS ERCP is valuable for detecting and treating postoperative biliary complications after surgery for hepatic echinococcal disease. In the majority of patients, endoscopic sphincterotomy allows healing of postoperative external biliary fistulas, and should be performed as early as possible. In some cases, a biliary prosthesis may be required. Endoscopic sphincterotomy also enables clearing of the bile ducts of hydatid remnants.
Collapse
Affiliation(s)
- Yilmaz Bilsel
- Istanbul University, Istanbul Medical Faculty, General Surgery Department, Gastrointestinal Surgery and Surgical Endoscopy Unit, Turkey
| | | | | | | | | | | | | |
Collapse
|
|
28
|
Abstract
Hydatid disease constitutes a serious public health problem throughout the world, especially in endemic areas, despite the use of various kinds of preventive measures. Currently, there are three treatment options for hepatic hydatid disease including surgery, PAIR (puncture, aspiration, injection, and re-aspiration), and chemotherapy with benzimidazole compounds. Each of these therapeutic modalities has limitations depending on the individual case. The authors review the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease (HHD) to clarify its place in the treatment algorithm among surgical, medical, and percutaneous measures. ERCP in the preoperative period: (1) defines the cystobiliary relationship to help in surgery planning, (2) permits evaluation for acute conditions like cholangitis and obstruction so that subsequent surgery can be performed on an elective basis, (3) may give permanent cure specifically in cases of frank intrabiliary rupture if evacuation of biliary tract and cystic cavity is manageable, and (4) when combined with preoperative endoscopic sphincterotomy may decrease the incidence of the development of postoperative external fistula. ERCP in the postoperative period: (1) can help to clarify the causes of ongoing or recurrent symptoms or laboratory abnormalities, (2) may help to resolve the obstruction or cholangitis due to residual material in biliary ducts, (3) may provide the chance to manage postoperative external biliary fistulae, and (4) may be a realistic solution for secondary biliary strictures. Considering the current literature and adding this experience, the authors propose a new treatment algorithm in HHD including medical, surgical, PAIR, and ERCP-related therapies. To illustrate the algorithm, a case is presented of a patient who had a persistent external biliary fistula in the postoperative period and was managed successfully by endoscopic approach.
Collapse
Affiliation(s)
- Ersan Ozaslan
- Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Ankara, Turkey
| | | |
Collapse
|
|
29
|
Affiliation(s)
- Mohammad Sultan Khuroo
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| |
Collapse
|
|
30
|
Giouleme O, Nikolaidis N, Zezos P, Budas K, Katsinelos P, Vasiliadis T, Eugenidis N. Treatment of complications of hepatic hydatid disease by ERCP. Gastrointest Endosc 2001; 54:508-10. [PMID: 11577320 DOI: 10.1067/mge.2001.118256] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy for preoperative and postoperative complications of hepatic hydatid disease. METHODS Nineteen patients underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in 1 and acute cholangitis in 4. In 14 patients treated after surgery (Group B), the indication was acute cholangitis in 6, obstructive jaundice 2, and persistent external drainage in 6 patients. OBSERVATIONS In group A, ERCP detected hydatid vesicles within the bile duct. All patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 6 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 20 days. Among the 8 patients with postoperative obstructive jaundice or acute cholangitis, 7 had cyst remnants obstructing the bile duct and 1 had findings of sclerosing cholangitis. All underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients, with the exception of the one with sclerosing cholangitis, remained asymptomatic. CONCLUSION Endoscopic sphincterotomy is a safe and effective treatment for biliary complications of hepatic hydatid disease.
Collapse
Affiliation(s)
- O Giouleme
- Division of Gastroenterology, 2nd Propedeutic Department of Medicine, Aristotle University, Hippokration Hospital, 49 Thihis Street, Thessaloniki 55133, Greece
| | | | | | | | | | | | | |
Collapse
|
|
31
|
Abstract
Tapeworms are among the oldest afflictions of humans. They continue, even today, to be an important cause of morbidity and mortality, worldwide. Taenia saginata and Taenia solium infections are still common in many developing countries. Diphyllobothrium latum infections, are decreasing, but this tapeworm, transmitted to humans through the eating of raw salmon, can cause severe anemia. Hymenolepis and Dipylidium infections may occur to children. Hydatid disease is a common cause of morbidity, especially among immigrant groups from endemic areas of the Mediterranean; the liver is the most common site of a hydatid cyst. Although surgery has been the mainstay of therapy, drug therapy and percutaneous aspiration have been used more frequently in recent years. praziquantel and albendazole are the two most useful drugs against various tapeworm infections.
Collapse
Affiliation(s)
- Herbert B. Tanowitz
- Departments of Pathology and Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA
| | | | | |
Collapse
|
|
32
|
Haddad MC, Huwaijah SH, Al-Kutoubi AO. Re: the safe use of cetrimide and hypertonic saline for percutaneous ablation of hepatic echinococcal cysts complicated by intrabiliary rupture. Cardiovasc Intervent Radiol 2000; 23:412-4. [PMID: 11060378 DOI: 10.1007/s002700010096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
|
33
|
Sáez-Royuela F, Yuguero L, López-Morante A, Pérez-Alvarez JC, Martín-Lorente JL, Ojeda C. Acute pancreatitis caused by hydatid membranes in the biliary tract: treatment with endoscopic sphincterotomy. Gastrointest Endosc 1999; 49:793-6. [PMID: 10343232 DOI: 10.1016/s0016-5107(99)70305-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- F Sáez-Royuela
- Department of Gastroenterology, "General Yagüe" Hospital, Burgos, Spain
| | | | | | | | | | | |
Collapse
|
|
34
|
Rodriguez AN, Sánchez del Río AL, Alguacil LV, De Dios Vega JF, Fugarolas GM. Effectiveness of endoscopic sphincterotomy in complicated hepatic hydatid disease. Gastrointest Endosc 1998; 48:593-7. [PMID: 9852449 DOI: 10.1016/s0016-5107(98)70041-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the results of endoscopic sphincterotomy in patients with hepatic hydatid cysts that have ruptured into the biliary tract. METHODS Over a 10-year period, 25 patients (11 men, 14 women, mean age 60 years) underwent treatment; 13 with no prior surgery were treated for biliary obstruction. Postoperative treatment was undertaken in 12 cases because of persistent drainage (8), duct obstruction (3), and postoperative pancreatitis (1). RESULTS In patients who had not undergone previous surgery, cholangiographic findings were hydatid vesicles in the biliary tract (6), dilation of the biliary tract (3), biliary fistula (2), distal stenosis (1), and purulent bile content after sphincterotomy (1). In all of these cases, sphincterotomy resolved duct obstruction with no complications. All patients with persistent postoperative drainage had a fistula tract between the biliary duct and the cavity, which was resolved by endoscopic treatment in all 8. The 3 patients with postoperative biliary obstruction had hydatid vesicles in the biliary tract, one with a long stenosis resembling sclerosing cholangitis, whereas the patient with postoperative pancreatitis had a distal stenosis. Satisfactory results were obtained with endoscopic sphincterotomy, although 1 patient required a biliary prosthesis. CONCLUSION Endoscopic sphincterotomy resolves biliary obstruction and postoperative fistulae in most patients with hepatic hydatid cysts that have ruptured into the biliary tract. In some cases, a biliary prosthesis may be required.
Collapse
Affiliation(s)
- A N Rodriguez
- Department of Gastroenterology, Reina Sofía University Hospital, Córdoba, Spain
| | | | | | | | | |
Collapse
|
|
35
|
Khuroo MS, Wani NA, Javid G, Khan BA, Yattoo GN, Shah AH, Jeelani SG. Percutaneous drainage compared with surgery for hepatic hydatid cysts. N Engl J Med 1997; 337:881-887. [PMID: 9302302 DOI: 10.1056/nejm199709253371303] [Citation(s) in RCA: 253] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In recent years percutaneous drainage has been used successfully to treat the hepatic hydatid cysts of echinococcal disease. We performed a controlled trial to compare the safety and efficacy of percutaneous drainage with those of surgical cystectomy, the traditional treatment. METHODS In a prospective study, we randomly assigned 50 patients with hepatic hydatidosis to treatment with percutaneous drainage (25 patients) or cystectomy (25). Albendazole (10 mg per kilogram of body weight per day for eight weeks) was administered to the patients who underwent percutaneous drainage. Serial assessments included clinical and biochemical examinations, ultrasonography, and serologic tests of echinococcal-antibody titers. RESULTS The mean (+/-SD) hospital stay was 4.2+/-1.5 days in the drainage group and 12.7+/-6.5 days in the surgery group (P<0.001). Over a mean follow-up period of 17 months, the mean cyst diameter decreased from 8.0+/-3.0 to 1.4+/-3.5 cm (P<0.001) after percutaneous drainage and from 9.1+/-3.0 to 0.9+/-1.8 cm (P<0.001) after surgery. The final cyst diameter did not differ significantly between the two groups (P=0.20). The cysts disappeared in 22 patients (88 percent) in the drainage group and in 18 (72 percent) in the surgery group (P=0.29). After an initial rise, the echinococcal-antibody titers fell progressively and at the last follow-up were negative (<1:160) in 19 patients (76 percent) in the drainage group and 17 (68 percent) in the surgery group (P=0.74). There were procedure-related complications in 8 patients (32 percent) in the drainage group and 21 (84 percent) in the surgery group, 17 of whom had fever postoperatively (P<0.001). CONCLUSIONS Percutaneous drainage, combined with albendazole therapy, is an effective and safe alternative to surgery for the treatment of uncomplicated hydatid cysts of the liver and requires a shorter hospital stay.
Collapse
Affiliation(s)
- M S Khuroo
- Department of Gastroenterology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | | | | | | | | |
Collapse
|
|
36
|
Abstract
Cystic echinococcosis has been recorded in 21 out of China's 31 provinces, autonomous regions and municipalities (approximately 87% of territory). It constitutes one of the major public health problems, especially in several northwestern provinces and autonomous regions. This paper reviews the general situation, diagnosis, treatment, education and control programmes and international cooperation. Special attention is given to the Xinjiang, an endemic area about one sixth of the country's area with a human population of approximately 16 million.
Collapse
Affiliation(s)
- H Wen
- Department of General Surgery, Xinjiang Medical College, Urumqi, People's Republic of China
| | | |
Collapse
|
|
37
|
Becker K, Frieling T, Saleh A, Häussinger D. Resolution of hydatid liver cyst by spontaneous rupture into the biliary tract. J Hepatol 1997; 26:1408-12. [PMID: 9210631 DOI: 10.1016/s0168-8278(97)80479-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Among the complications of hydatid liver disease, spontaneous cyst rupture into the biliary tract is unusual, occurring in 3.2-17% of cases. Its endoscopic management has been reported rarely, and corresponding complete photodocumentation is unique. Such a case is described and comprehensively illustrated in a 48-year-old immunocompromised man, presenting with upper abdominal pain, obstructive jaundice, and fever. Impaction of hydatid material into the common bile duct and the papilla of Vater was relieved endoscopically, and the patient was consecutively treated with two courses of mebendazole. This management resulted in complete clinical resolution of hepatic hydatosis after 8 months of follow-up. Complications of overt cyst perforation may be allergic, obstructive, secondary infectious, or metastatic. Ultrasound and computed tomography are complementary tools for diagnosis of hepatic echinococcosis, with endoscopic retrograde cholangiography being the "gold standard" in confirming rupture into the biliary system. Laboratory results are usually non-specific. While surgical excision is the treatment of choice, selected patients may primarily be managed endoscopically, followed by anthelminthic therapy.
Collapse
Affiliation(s)
- K Becker
- Department of Gastroenterology and Infectious Diseases, Heinrich Heine University Medical Center, Düsseldorf, Germany
| | | | | | | |
Collapse
|
|
38
|
Klingler PJ, Gadenstätter M, Schmid T, Bodner E, Schwelberger HG. Treatment of hepatic cysts in the era of laparoscopic surgery. Br J Surg 1997. [PMID: 9112889 DOI: 10.1002/bjs.1800840405] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Liver cysts are not uncommon. Rarely, they become symptomatic and require intervention. Surgery is the usual form of treatment; laparoscopic cyst unroofing has recently been introduced. METHODS The current status of diagnosis and conventional therapy of hepatic cysts was summarized. The surgical literature was surveyed to collect all reported cases of minimally invasive treatment of these lesions, and the advantages and limitations of the methods were evaluated. RESULTS AND CONCLUSION The general application of the minimally invasive technique should await a thorough evaluation of the operative complications and the outcome in terms of cyst recurrence in larger series of patients. However, laparoscopic wide cyst unroofing and laparoscopic cyst excision will probably become the methods of choice for the treatment of symptomatic liver cysts in carefully selected patients.
Collapse
Affiliation(s)
- P J Klingler
- Second Department of Surgery, University of Innsbruck, Austria
| | | | | | | | | |
Collapse
|
|
39
|
Abstract
This article deals with cystic echinococcosis (CE) and alveolar echinococcosis in humans caused by the cestode parasites Echinococcus granulosus and Echinococcus multilocularis. The life cycles of these parasites and their epidemiologic aspects are briefly discussed, and a detailed review is presented on clinical aspects of the diseases, including diagnosis and therapy. Considerable progress has been made in chemotherapy but the results are not yet satisfactory. A new alternative for treatment of CE is puncture of cysts, aspiration of fluid, injection of ethanol, and reaspiration of fluid (PAIR).
Collapse
Affiliation(s)
- R W Ammann
- Department of Medicine, University Hospital, Zürich, Switzerland
| | | |
Collapse
|
|
40
|
Dias LM, Silva R, Viana HL, Palhinhas M, Viana RL. Biliary fascioliasis: diagnosis, treatment and follow-up by ERCP. Gastrointest Endosc 1996; 43:616-20. [PMID: 8781945 DOI: 10.1016/s0016-5107(96)70203-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- L M Dias
- Department of Gastroenterology, Instituto Português de Oncologia do Porto, Portugal
| | | | | | | | | |
Collapse
|
|
41
|
Spiliadis C, Georgopoulos S, Dailianas A, Konstantinidis A, Rimikis M, Skandalis N. The use of ERCP in the study of patients with hepatic echinococcosis before and after surgical intervention. Gastrointest Endosc 1996; 43:575-9. [PMID: 8781936 DOI: 10.1016/s0016-5107(96)70194-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Biliary tree involvement is the most common complication of hydatid liver disease, which is difficult to detect and manage. METHODS During the last 7 years, we examined by ERCP 26 cases with echinococcal liver involvement. Indications in the preoperative group included cholangitis in 6 cases, right-sided hypochondralgia involving 4, preoperative assessment in 4, and icterus in 1 case. In the postoperative group, the indications for ERCP were cholangitis in 5 cases, external biliary fistulas in 5, and biliary colic in 1 case. RESULTS ERCP findings in the preoperative group included external bile duct compression in 11 cases (73.3%), biliary fistula affecting 3 (20%), and echinococcal remnants within the common bile duct in 1 case (6.6%). With regard to the postoperative group, biliary fistula formation was detected in 6 cases (54.5%), echinococcal remnants within the common bile duct in 4 (36.3%), and external bile duct compression involving 1 case (9%). Endoscopic sphincterotomy was successfully performed in 13 patients in both groups. No serious complications were encountered. CONCLUSION ERCP is a safe and helpful preoperative or postoperative tool that aids in the diagnosis and often the treatment of echinococcal liver disease with involvement of the bile ducts.
Collapse
Affiliation(s)
- C Spiliadis
- Department of Gastroenterology, General Hospital of Athens, Greece
| | | | | | | | | | | |
Collapse
|