Sheikh Atiq-ur Rehman, Muhammad Siddique, Ahmad Yar, Gulzar Ahmad, Muhammad Mazhar Bashir.
Surgical management of obstructive jaundice due to spontaneous intrabiliary rupture of hydatid cysts of the liver.
Pak J Surg Jan ;32(4):207-12.

Purpose: To evaluate the clinical presentation, operative findings & postoperative course of patients with intrabiliary rupture of hydatid cyst of the liver. Place & period: The study was conducted in surgical units, Bahawal Vicotria Hospital, Bahawalpur, Pakistan from 01-01-2004 to 31-12-2015. Material & method: Th is was a prospective type of observational case series study. All patients of either sex & age being diagnosed as case of obstructive jaundice due intrabiliary rupture of hepatic hydatid disease were included in the study. Using a standardized data collection instrument, clinical case record of all patients who were operated for intrabiliary rupture of hydatid cyst of the liver was noted. Results: 20 patients (13 males, 7 females) with intrabiliary rupture of hepatic hydatid cyst were enrolled. The age range was from 30-70 years. The most frequent symptoms were right upper quadrant/epigastric pain, jaundice and pruritus. Diagnosis of hydatid cyst was principally made using ultrasonography. 14(70%) cysts were located in the right lobe, 3 (15%) in the left lobe, and 3 (15%) in the both lobes. The size of the cysts was from 05-20 cm. Common bile duct (CBD) was dilated in 40% patients. CBD exploration was done in all patients. T-tube drainage of CBD was done in 18(90%) patients. Choledochoduodenostomy was done in 2(10%) patients. Postoperative course was uneventful in 12(60%) patients. Wound infections developed in 3(15%) patients, suppuration of the residual cavity in 3(15%) patients, septicemia and renal failure in 2 (10%) patients and wound dehiscence & GI bleeding in one patient each. The hospital stay was 7-25 days. All patients were given 8 week course of albendazole or mebendazole postoperatively. Two patients (10%) died from sepsis & multiple organ failure. Conclusion: An unusual cause of obstructive jaundice due intrabiliary of hepatic hydatid cyst is daughter cysts and or sludge in the CBD. If a dilated CBD and bile-stained cystic fluid is found in patients with hydatid disease of the liver, common bile duct exploration should be performed during operation. Surgical removal of the cyst from CBD resulted in complete resolution of jaundice. Treatment with oral albendazole was given pre-operatively and continued for two months after surgery.

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