- A 28 year old female presented with pain in abdomen over RHC, fever and jaundice since 1 month
- EUS- dilated CBD with a sludge and hydatid daughter cysts within
- ERC- Duodenoscopy revealed bulging ampulla with hydatid daughter cyst at the opening
- Cholangiogram- sludge and hydatid daughter cysts within CBD with massively dilated right ductal system
- Biliary Sphincterotomy was performed. Hydatid daughter cyst extraction was carried out with balloon catheter. Sudden gush of infected bile and hydatid daughter cysts were seen
- A 7 Fr double pigtail stent was placed in to the right ductal system to ensure free flow of bile
- Follow up after 6 weeks- patient was asymptomatic. Duodenoscopy revealed biliary stent in situ.
- Previously placed double pig tail stent was removed.
- Cholangiogram showed the hydatid cyst cavity in the right lobe and right ductal system with daughter cyst membranes. Hydatid daughter cyst membrane extraction was carried out with balloon catheter.
- In view of residual hydatid cyst membranes in to the right ductal system and right lobe of liver a 7 Fr double pigtail stent was placed in to the right ductal system and a 7 Fr Teflon stent was placed in to the left ductal system to ensure free flow of bile.
- Patient underwent laparoscopic marsupialization procedure for residual cavity and stent removal was performed after 4 weeks. Patient was asymptomatic on further clinical follow ups.
- Early diagnosis and proper management are mandatory in these patients, since serious clinical complications with an increased mortality may ensue
- ERC proved to be a choice offering excellent immediate and short-term post procedure results. The success rate of endoscopic treatment appears to be satisfactory at 90 – 100%
Take home message-
- Endoscopic treatment is one of the therapeutic options of a ruptured hepatic hydatid cyst into the biliary tract9 and it is both safe and effective
- Percutaneous approach with PAIR (Percutaneous aspiration instillation and re aspiration) should not be performed in patients with cyst-biliary communication