The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Management of Intra-Biliary Rupture of Liver Hydatid Cysts (IBRH): Follow-Up of 12 Cases
Author(s)
Mohammad Abdulrahman Alshekhani*,
Taha A. Alkarbuli,
Naser Abdullah Mohammed Alqazi,
Hiwa A. Hussein,
Qalandar H. Kasnazan,
Ali Hussein Ali
Affiliation(s)
Kurdistan Center for Gastroenterology & Hepatology, Asulaimaneyah, Iraqi Kurdistan, Iraq.
Kurdistan Center for Gastroenterology & Hepatology, Asulaimaneyah, Iraqi Kurdistan, Iraq.
ABSTRACT
Background: Intra-biliary rupture of hydatid cyst [IBRH] is not a rare complication of hydatid disease of the liver and surgery until recently is the only definitive treatment. With the introduction of ERCP preoperatively or postoperatively there was a great reduction in the operative complications. There were reports in which the ERCP was the sole treatment of this condition. Objective: To evaluate role of ERCP in the management of cases of IBRH. Design: A retrospective study of 7 cases of IBRH and prospective study of 5 cases of IBRH managed by ERCP. Setting: The ERCP Unit of Kurditan Center for Gastroenterology & Hepatology, Asulaimaneyah-Iraqi, Kurdistan, Iraq. Main Outcome Measurements: Improvement in the symptoms, obstructive liver functions pattern and ultrasonic findings in these patients following ERCP management. Methods: This is a study of 12 cases of IBRH managed by ERCP in the Kurdistan Center of Gastroenterology (KCGE) in Asulaimaneyah-Iraq, from 2007-2010. Seven cases of these were studied retrospectively from the available information on the center computers and on follow-up of these patients, while the other five patients were studied prospectively during the study period. We collected the available information: laboratory investigations, trans-abdominal ultrasonography (TAUS), computed tomography (CT) or magnetic resonance images (when available), before and after ERCP. We depended on the liver functions, trans-abdominal ultrasound and the clinical presentation before and after the ERCP; some patients were contacted via mobile phone for follow-up. Results: Cases were more males than females (58% vs 42%); most were from the ages between 30 - 50 years. The clinical presentation was fever, jaundice, itching and right hypochondrial pain in most patients. The liver function tests were obstructive pattern with elevated direct bilirubin and alkhaline phosphates in most patients. The trans-abdominal ultrasound revealed dilated common bile duct and single liver cyst in most patients and 2 or 3 cysts in others. The ERCP management led to improvement in clinical, laboratory and ultrasonic findings in 6 patients and in these 6 patients ERCP was the only procedure needed and proved by follow-up of these patients for 1 year in 4 patients and 2 years in the other 2 patients, especially in those with hydatid mebranes seen at ERCP and those with cholangiographic evidence of communication with the cyst; surgery was needed in 5 cases and one patient died from septic shock. Conclusions: ERCP is an important management strategy for patients with IBRH, which can lead to clinical, laboratory and ultrasonographic improvements, and can be the only required procedure in more than 50% of cases especially in those with hydatid mebranes seen at ERCP and those with cholangiographic evidence of communication with the cyst.
Background: Intra-biliary rupture of hydatid cyst [IBRH] is not a rare complication of hydatid disease of the liver and surgery until recently is the only definitive treatment. With the introduction of ERCP preoperatively or postoperatively there was a great reduction in the operative complications. There were reports in which the ERCP was the sole treatment of this condition. Objective: To evaluate role of ERCP in the management of cases of IBRH. Design: A retrospective study of 7 cases of IBRH and prospective study of 5 cases of IBRH managed by ERCP. Setting: The ERCP Unit of Kurditan Center for Gastroenterology & Hepatology, Asulaimaneyah-Iraqi, Kurdistan, Iraq. Main Outcome Measurements: Improvement in the symptoms, obstructive liver functions pattern and ultrasonic findings in these patients following ERCP management. Methods: This is a study of 12 cases of IBRH managed by ERCP in the Kurdistan Center of Gastroenterology (KCGE) in Asulaimaneyah-Iraq, from 2007-2010. Seven cases of these were studied retrospectively from the available information on the center computers and on follow-up of these patients, while the other five patients were studied prospectively during the study period. We collected the available information: laboratory investigations, trans-abdominal ultrasonography (TAUS), computed tomography (CT) or magnetic resonance images (when available), before and after ERCP. We depended on the liver functions, trans-abdominal ultrasound and the clinical presentation before and after the ERCP; some patients were contacted via mobile phone for follow-up. Results: Cases were more males than females (58% vs 42%); most were from the ages between 30 - 50 years. The clinical presentation was fever, jaundice, itching and right hypochondrial pain in most patients. The liver function tests were obstructive pattern with elevated direct bilirubin and alkhaline phosphates in most patients. The trans-abdominal ultrasound revealed dilated common bile duct and single liver cyst in most patients and 2 or 3 cysts in others. The ERCP management led to improvement in clinical, laboratory and ultrasonic findings in 6 patients and in these 6 patients ERCP was the only procedure needed and proved by follow-up of these patients for 1 year in 4 patients and 2 years in the other 2 patients, especially in those with hydatid mebranes seen at ERCP and those with cholangiographic evidence of communication with the cyst; surgery was needed in 5 cases and one patient died from septic shock. Conclusions: ERCP is an important management strategy for patients with IBRH, which can lead to clinical, laboratory and ultrasonographic improvements, and can be the only required procedure in more than 50% of cases especially in those with hydatid mebranes seen at ERCP and those with cholangiographic evidence of communication with the cyst.
Cite this paper
Alshekhani, M. , Alkarbuli, T. , Alqazi, N. , Hussein, H. , Kasnazan, Q. and Ali, A. (2014) The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Management of Intra-Biliary Rupture of Liver Hydatid Cysts (IBRH): Follow-Up of 12 Cases. Case Reports in Clinical Medicine, 3, 533-543. doi: 10.4236/crcm.2014.39117.
Alshekhani, M. , Alkarbuli, T. , Alqazi, N. , Hussein, H. , Kasnazan, Q. and Ali, A. (2014) The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Management of Intra-Biliary Rupture of Liver Hydatid Cysts (IBRH): Follow-Up of 12 Cases. Case Reports in Clinical Medicine, 3, 533-543. doi: 10.4236/crcm.2014.39117.
References
[1] Demircan, O., Baymus, M., Seydaoglu, G., Akinoglu, A. and Sakman, G. (2006) Occult Cystobiliary Communication Presenting as Post Operative Biliary Leakage after Hydatid Liver Surgery: Are There Significant Preoperative Clinical Predictors. Canadian Journal of Surgery, 49, 177-184. [2] Chautems, R., Bühler, L.H., Gold, B., Giostra, E., Poletti, P., Chilcott, M., et al. (2005) Surgical Management and Long Term Outcome of Complicated Liver Hydatid Cyst Caused by Echinococcus granulosus. Surgery, 137, 312-316.
http://dx.doi.org/10.1016/j.surg.2004.09.004 [3] Akkiz, H., Akinoglu, A., Colakoglu, S., et al. (1996) Endoscopic Management of Biliary Hydatid Disease. Canadian Journal of Surgery, 39, 287-292. [4] Kumar, R., Reddy, S.N. and Thulkar, S. (2002) Intrabiliary Rupture of Hydatid Cyst: Diagnosis with MRI and Hepatobiliary Isotope Study. British Journal of Radiology, 75, 271-274.
http://dx.doi.org/10.1259/bjr.75.891.750271 [5] Avecu, S., ünal, Ö. and Arslan, H. (2009) Intrabiliary Rupture of Hydatid Cyst: A Case Report and Review of Literature. Cases Journal, 2, 1757-1762. [6] Sparchez, Z., Osian, G., Onica, A., Barbanta, C., Tantau, M. and Pascu, O. (2004) Rupture Hydatid Cyst of the Liver with Biliary Obstruction: Presentation of a Case and Review of the Literature. Romanian Journal of Gastroenterology, 13, 245-250. [7] Erzurmlu, K., Dervisoglu, A., Polat, C., Senyurek, G., Yetim, I. and Hokelek, M. (2005) Intrabiliaryrupture: Analgorithmin the Treatment of Controversial Complication of Hepatic Hydatidosis. World Journal of Gastroenterology, 11, 2472. [8] Choh, N.A., Choh, S.A. and Jehangir, M. (2008) Intrabiliary Rupture of Hydatid Cyst Demonstrated by Magnetic Resonance Cholangiopancreatography. Archives of Disease in Childhood, 93, 441.
http://dx.doi.org/10.1136/adc.2008.138354 [9] Sharma, M., Somasundaram, A., Pathak, A., et al. (2010) Endoscopic Ultrasound in Hepatobiliary Hydatid Disease. Endoscopy, 42, E56-E57.
http://dx.doi.org/10.1055/s-0029-1243830 [10] Izadpanah, A. and Saidi, F. (2006) Asymptomatic Liver Hydatidcysts; a Preferred Approach. Iranian Journal of Medical Sciences, 31, 1-4. [11] Özaslan, E. (2006) Therapeutic Endoscopic Retrograde Cholangiopancreatography and Related Modalities Have Many Roles in Hepatobiliary Hydatid Disease. World Journal of Gastroenterology, 12, 4930-4931. [12] Galati, G., Sterpetti, A.V., Caputo, M., Adduci, M., Lucandri, G., Brozzetti, S., et al. (2006) Endoscopic Retrograde Cholangiography for Intrabiliary Rupture of Hydatid Cyst. The American Journal of Surgery, 191, 206-210.
http://dx.doi.org/10.1016/j.amjsurg.2005.09.014 [13] (2006) 14th United European Gastroenterology Week (UEGW). Berlin, 21-25 October 2006, Selected Endoscopy Reports. [14] Saouab, R., Semlali, S., Mahi, M., Amil, T., Hanine, A., Benameur, A. and Chaouir, S. (2010) Intrabiliary Rupture of Hydatid Cyst: Imaging Findings. Mohamed 5th Military Hospital, Rabat-Morocco. [15] Khuroo, M.S. (2002) Hydatid Disease: Current Status and Recent Advances. Annals of Saudi Medicine, 22, 56-64. [16] Mentes, O., Yigit, T., Ozer, T., Uzar, A.I., Kozak, O., Arsalan, I. and Tufan, T. (2006) Unexpected Complication of Liver Hydatid Cyst Disease: A Frank Rupture to Biliary Channels at Both Main Sides: Report of a Rare Case. Balkan Military Medical Review, 9, 161-163. [17] Saracino, A., Scotto, G., Ciavarella, G., Natale, C., Palumbo, E., Cibelli, D.C. and Angarano, G. (2004) Intrabiliary Rupture of Ahydatid Liver Cyst: A Case Report. The New Microbiologica, 27, 301-303. [18] Emre, A., Ariogul, O., Alper, A., Ökten, A., Uras, A. and Yalçin, S. (1990) Hydatid Cysts of the Liver and Portal Hypertension. HBP Surgery, 2, 129-133. [19] Sumer, A., Caglayan, K., Altinli, E. and Koksal, N. (2009) Case Report: Spontaneous Liver Hydatidcystrupture in a Child. Israeli Journal of Medicine, 9. [20] Sahin, D.A., Kusaslan, R., Sahin, O. and Dilek, O.N. (2007) Hugehydatid Cysts That Arise from the Liver, Growing Exophytically. Canadian Journal of Surgery, 50, 301-303. [21] Reddy, D.N. (2009) Endoscopic Diagnosis and Management of Biliary Parasitosis. [22] Lewall, D.B. and McCorkell, S.J. (1986) Rupture of Echinococcal Cysts: Diagnosis, Classification, and Clinical Implications. American Journal of Roentgenology, 146, 391-394.
http://dx.doi.org/10.2214/ajr.146.2.391
[1] Demircan, O., Baymus, M., Seydaoglu, G., Akinoglu, A. and Sakman, G. (2006) Occult Cystobiliary Communication Presenting as Post Operative Biliary Leakage after Hydatid Liver Surgery: Are There Significant Preoperative Clinical Predictors. Canadian Journal of Surgery, 49, 177-184. [2] Chautems, R., Bühler, L.H., Gold, B., Giostra, E., Poletti, P., Chilcott, M., et al. (2005) Surgical Management and Long Term Outcome of Complicated Liver Hydatid Cyst Caused by Echinococcus granulosus. Surgery, 137, 312-316.
http://dx.doi.org/10.1016/j.surg.2004.09.004 [3] Akkiz, H., Akinoglu, A., Colakoglu, S., et al. (1996) Endoscopic Management of Biliary Hydatid Disease. Canadian Journal of Surgery, 39, 287-292. [4] Kumar, R., Reddy, S.N. and Thulkar, S. (2002) Intrabiliary Rupture of Hydatid Cyst: Diagnosis with MRI and Hepatobiliary Isotope Study. British Journal of Radiology, 75, 271-274.
http://dx.doi.org/10.1259/bjr.75.891.750271 [5] Avecu, S., ünal, Ö. and Arslan, H. (2009) Intrabiliary Rupture of Hydatid Cyst: A Case Report and Review of Literature. Cases Journal, 2, 1757-1762. [6] Sparchez, Z., Osian, G., Onica, A., Barbanta, C., Tantau, M. and Pascu, O. (2004) Rupture Hydatid Cyst of the Liver with Biliary Obstruction: Presentation of a Case and Review of the Literature. Romanian Journal of Gastroenterology, 13, 245-250. [7] Erzurmlu, K., Dervisoglu, A., Polat, C., Senyurek, G., Yetim, I. and Hokelek, M. (2005) Intrabiliaryrupture: Analgorithmin the Treatment of Controversial Complication of Hepatic Hydatidosis. World Journal of Gastroenterology, 11, 2472. [8] Choh, N.A., Choh, S.A. and Jehangir, M. (2008) Intrabiliary Rupture of Hydatid Cyst Demonstrated by Magnetic Resonance Cholangiopancreatography. Archives of Disease in Childhood, 93, 441.
http://dx.doi.org/10.1136/adc.2008.138354 [9] Sharma, M., Somasundaram, A., Pathak, A., et al. (2010) Endoscopic Ultrasound in Hepatobiliary Hydatid Disease. Endoscopy, 42, E56-E57.
http://dx.doi.org/10.1055/s-0029-1243830 [10] Izadpanah, A. and Saidi, F. (2006) Asymptomatic Liver Hydatidcysts; a Preferred Approach. Iranian Journal of Medical Sciences, 31, 1-4. [11] Özaslan, E. (2006) Therapeutic Endoscopic Retrograde Cholangiopancreatography and Related Modalities Have Many Roles in Hepatobiliary Hydatid Disease. World Journal of Gastroenterology, 12, 4930-4931. [12] Galati, G., Sterpetti, A.V., Caputo, M., Adduci, M., Lucandri, G., Brozzetti, S., et al. (2006) Endoscopic Retrograde Cholangiography for Intrabiliary Rupture of Hydatid Cyst. The American Journal of Surgery, 191, 206-210.
http://dx.doi.org/10.1016/j.amjsurg.2005.09.014 [13] (2006) 14th United European Gastroenterology Week (UEGW). Berlin, 21-25 October 2006, Selected Endoscopy Reports. [14] Saouab, R., Semlali, S., Mahi, M., Amil, T., Hanine, A., Benameur, A. and Chaouir, S. (2010) Intrabiliary Rupture of Hydatid Cyst: Imaging Findings. Mohamed 5th Military Hospital, Rabat-Morocco. [15] Khuroo, M.S. (2002) Hydatid Disease: Current Status and Recent Advances. Annals of Saudi Medicine, 22, 56-64. [16] Mentes, O., Yigit, T., Ozer, T., Uzar, A.I., Kozak, O., Arsalan, I. and Tufan, T. (2006) Unexpected Complication of Liver Hydatid Cyst Disease: A Frank Rupture to Biliary Channels at Both Main Sides: Report of a Rare Case. Balkan Military Medical Review, 9, 161-163. [17] Saracino, A., Scotto, G., Ciavarella, G., Natale, C., Palumbo, E., Cibelli, D.C. and Angarano, G. (2004) Intrabiliary Rupture of Ahydatid Liver Cyst: A Case Report. The New Microbiologica, 27, 301-303. [18] Emre, A., Ariogul, O., Alper, A., Ökten, A., Uras, A. and Yalçin, S. (1990) Hydatid Cysts of the Liver and Portal Hypertension. HBP Surgery, 2, 129-133. [19] Sumer, A., Caglayan, K., Altinli, E. and Koksal, N. (2009) Case Report: Spontaneous Liver Hydatidcystrupture in a Child. Israeli Journal of Medicine, 9. [20] Sahin, D.A., Kusaslan, R., Sahin, O. and Dilek, O.N. (2007) Hugehydatid Cysts That Arise from the Liver, Growing Exophytically. Canadian Journal of Surgery, 50, 301-303. [21] Reddy, D.N. (2009) Endoscopic Diagnosis and Management of Biliary Parasitosis. [22] Lewall, D.B. and McCorkell, S.J. (1986) Rupture of Echinococcal Cysts: Diagnosis, Classification, and Clinical Implications. American Journal of Roentgenology, 146, 391-394.
http://dx.doi.org/10.2214/ajr.146.2.391