Cystobiliary Communication Research Articles

Outcome of minimal surgery for hydatid cysts of the liver in children with reference to post-operative biliary leakage.

Analysis of 30 children with hydatid cysts of the liver who were treated by partial pericystectomy and external tube drainage showed that five (21%) of 24 cases in whom clear hydatid fluid was observed during surgery developed biliary leakage. The cysts in the remaining six contained bile-stained fluid, indicating the presence of cystobiliary communications, and five of these children continued to drain bile post-operatively, in spite of appropriate precautions taken during surgery. Histological examination of the pericyst wall confirmed the presence of openings of small bile ducts in the cyst which probably caused the biliary leak. It is possible that some larger openings were overlooked during surgery. It is concluded from this study that biliary leakage during the post-operative period should be expected in a significant number of patients subjected to surgery for hydatid cysts of the liver. However, the leak is likely to cease spontaneously, providing distal biliary duct obstruction is ruled out and external tube drainage is used to prevent accumulation of bile in the pericyst cavity.

Spontaneous communication of a liver cyst with the bile ducts diagnosed by ERCP

Solitary liver cysts and polycystic liver disease (PLD) are usually asymptomatic. Large cysts can cause complications, usually as a result of the space-occupying effect, with compression of adjacent organs and particularly the bile ducts.1,2 Liver cysts can also have other complications such as intracystic hemorrhage,3,4 cyst infection,5 rupture,6 torsion,7 fistulization into the duodenum,8 and malignant degeneration.5 Cystobiliary communication is a rare complication.9 It is either due to the presence of ductules in the cyst wall2,10,11 or to fistulization which can be either spontaneous5,9 or secondary to hemorrhage.

Capsectomy and Drainage in Hepatic Hydatidosis

We present our surgical technique for treating hepatic hydatidosis. This includes careful evacuation of the hydatid cyst through a wide capsectomy, interlocking suturing of the edges of the remaining cavity and postoperative drainage with negative pressure, closed drainage systems. During the operation, the abdomen is carefully isolated and strict precautions are taken to avoid spillage of hydatid fluid. Technical details on treating cystobiliary communications and exogenous daughter cysts are also described. As shown in our series, this method has very acceptable postoperative results, avoiding the complications of more aggressive operations, applied in other centres for the treatment of hydatid disease.

Value of ERCP in the diagnosis and management of pre- and postoperative biliary complications in hydatid disease of the liver.

Twenty-nine patients with symptomatic hydatid disease of the liver were evaluated preoperatively by endoscopic retrograde cholangiopancreatography (ERCP) in the years 1982-1987. In the same period, 6 patients who previously underwent surgery for the parasitic disease also underwent ERCP because of postoperative symptoms of biliary obstruction. Findings at ERCP excluded biliary tract involvement in 11 cases. Positive findings were shown in 24 patients, including compression of the bile ducts in 4, small cysto-biliary communications in 5, intrabiliary rupture in 9, residual hydatid material in the common bile duct, and sclerosing cholangitis in 3. Endoscopic removal of migrated hydatid debris was achieved in 8 patients, avoiding reoperation in 4.