Complicated Hepatic Hydatid Cysts with Rupture into the Biliary Ducts

Abstract

Introduction: Liver echinococcosis is an endemic disease in the Republic of North Macedonia. The liver is the most frequent site of involvement accounts for 65-75% of cases. Rupture of a hydatid cyst into the biliary tree is the most common complication, occurring in 5-25% of patients. Aim of this research work is to present the important role of radiological imaging examinations in diagnosis of this parasitic infection, and it is complications including rupture of hepatic hydatid cysts into the biliary tree. Case presentation: We are presenting a female 68-year-old patient, with obstructive jaundice, right subcostal pain, nausea, vomiting, fatigue, and weight loss. Ultra Sound (US) and Computed Tomography (CT) examinations are perform and we found two suppurated hydatid cysts in the liver, with a diameter between 65 and 105 mm. One of them penetrated the biliary system creating a fistula. The gallbladder was chronically inflamed, filled with gallstones, and with a thickened wall. The patient underwent surgery and the hydatid cysts and gallbladder had completely removed, and the continuity of the biliary stem was established. Conclusion: The postoperative finding completely matched the preoperative US and CT diagnosis. Cysto-biliary communication is more common in large cyst size, located in the central segments of the liver close to the biliary confluence. The postoperative finding completely matched the preoperative US and CT diagnosis.