INTRABILIARY OBSTRUCTION DUE TO RUPTURED HEPATIC HYDATID CYST: EVALUATION WITH COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING

Abstract

Background: One of the most common and very serious complications of a hepatic echinococcal cyst is the intrabiliary rupture of the cyst and, in some cases, the obstruction of the biliary system. The effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) was evaluated for the preoperative diagnosis of hydatid cyst into the biliary tree.Methods: The techniques of CT, MRI and magnetic resonance (MR) cholangiography were used to examine nine cases of intrabiliary rupture of the hepatic hydatid cyst. The confirmation of the diagnosis was made at surgery in four cases and with endoscopic retrograde cholangiopancreatography in five cases.Results: By using CT and MRI, the intrabiliary rupture of an echinococcal cyst was diagnosed readily and accurately in all cases. In eight cases, we found a dilated intrahepatic biliary vessel near the ruptured echinococcal cyst, without any evidence of communication between the cyst and the biliary system. Also in six cases there was an abnormal configuration of the terminal part of the biliary radicle.Conclusion: This study suggests that a dilated biliary radicle with conical configuration of its end‐part and in close proximity with hydatid cyst is strong evidence of previous or active rupture of hydatid cyst into the biliary system. A combined study of CT or MRI and MR cholangiography is mandatory for proper preoperative evaluation of the intrabiliary rupture of hepatic hydatid cyst.