1
|
Jiang T, Wang Z, Aji T, Ran B, Guo Q, Zhang R, Tuergan T, Zhong K, Shao Y, Hao W. ERCP management of acute cholangitis caused by rupture of Echinococcus hepaticus into the biliary tract. J Minim Access Surg 2023; 19:498-503. [PMID: 37282433 PMCID: PMC10695320 DOI: 10.4103/jmas.jmas_219_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/24/2022] [Accepted: 02/09/2023] [Indexed: 06/08/2023] Open
Abstract
Background Hepatic cystic echinococcosis (HCE) rupture into the biliary tract, one of the most common and refractory complications, is treated by laparotomy to remove hydatid lesions. The aim of this article was to investigate the role of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of this particular disease. Patients and Methods This was is a retrospective analysis of 40 patients with HCE ruptured into the biliary tract in our hospital from September 2014 to October 2019. They were divided into two groups, ERCP group (group A, n = 14) and conventional surgery group (group B, n = 26). Group A was treated with ERCP first to control infection and improve the general condition before undergoing laparotomy at an optional stage while group B was treated with laparotomy directly. First, the infection parameters and liver, kidney and coagulation functions of group A patients before and after ERCP were compared to evaluate treatment effectiveness. Second, the intraoperative and post-operative parameters during the laparotomy of group A were compared with group B to evaluate the impact of ERCP treatment on laparotomy. Results and Conclusions White blood cell, NE%, platelet, procalcitonin, C-reactive protein, interleukin-6, Total bilirubin (TBIL), alkaline phosphatase, gamma-glutamyl transpeptidase, aspartate transaminase, alanine transaminase (ALT), ALT and Cr in group A significantly improved by ERCP (P < 0.05); during laparotomy, the bleeding amount and hospital stay in group A were better (P < 0.05); moreover, concerning the post-operative complications, the incidence of acute renal failure and coagulation dysfunction in group A was significantly less (P < 0.05). ERCP, which not only quickly and effectively controls infection and improves the patient's systemic condition but also provides good support for subsequent radical surgery, enjoys good prospects for clinical application.
Collapse
Affiliation(s)
- Tiemin Jiang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zongding Wang
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary Surgery, Fengjie County People’s Hospital of Chongqing, 404600, P. R. China
| | - Tuerganaili Aji
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bo Ran
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Guo
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ruiqing Zhang
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Kai Zhong
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yingmei Shao
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wen Hao
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, The First Clinical Medical College of Xinjiang Medical University, Urumqi, China
- Department of Hepatobiliary and Hydatid Diseases, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| |
Collapse
|
2
|
DİZEN H, YALINBAŞ KAYA B. Surgical treatment of liver hydatic cyst and evaluation of cystobiliary fistula: experience of two centers. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1112941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Intrabiliary rupture or cystobiliary fistula is the most common complication of hepatic hydatid cyst. In this article, our objective is to evaluate the clinical, laboratory, imaging, surgical treatment and results of cystobiliary fistulas, which is the most common complication of hydatid cysts.
Material and Method: In our study, patients who underwent open surgery and were followed up and treated for hydatid cyst in the gastroenterology and general surgery outpatient clinic and service between years 2015-2021 were included. The clinical, laboratory, radiological and surgical results of 171 patients with hydatid cysts were retrospectively analyzed.
Results: The mean age of 171 patients who underwent surgery for hydatid cyst was 44.8 (18-71), 68 of whom were men and 103 were women. Bile leakage was present in 50 patients (50 (29.23%)). There were 24 (48%) men and 26 (52%) women with bile leakage. The cyst diameter was 74.2 (36-170) mm and the number of cysts was 1.2 (1-2). The cysts were located in the right lobe of the liver in 116 (79%) patients, in the left lobe in 30 (15%) patients, and in both lobes in 25 (6%) patients. Cystobiliary fistula developed more frequently, especially in cysts located in the right lobe(36 (72%)). Cystobiliary fistula was most common in CE3 (Gharbi type 2) type (30 (60%)). Cystectomy+drainage was performed in 137 (80%) patients in all groups. Cystectomy and drainage were the most common surgical procedures. The cyst diameter was 10 cm in the group with cystobiliary fistula and was significant compared to the group without fistula (p<0.001). Aminotransferase (AST and ALT) levels were high in patients with cystobiliary fistula (p=0.012, p=0.054). However, there was no significant difference between the two groups in alkaline phosphatase, total bilirubin, and gamma glutamyl transferase (p=0.231, p=0.097, p=0.544).
Conclusion: Liver hydatid cyst is endemic in our country as well as in many other countries in the world. Complicated hepatic hydatid cysts require timely and appropriate treatment because of their life-threatening complications. Cytobiliary fistula is the most common complication. In the surgical treatment of hydatid cyst disease, the earlier the diagnosis of occult cystobiliary fistulas is made (especially in the preoperative or peroperative period), the easier the treatment is, and the risk of bile leakage and consequently the morbidity and mortality decreases. Our results and experience showed that treatment and complications are related to the location and size of the cyst, occult/large cystobiliary fistula, detectability of occult fistulas, experienced center and surgeon.
Collapse
Affiliation(s)
| | - Berrin YALINBAŞ KAYA
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ESKİŞEHİR ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ
| |
Collapse
|
3
|
Shalayiadang P, Jiang T, Yimiti Y, Ran B, Aini A, Zhang R, Guo Q, Ahan A, Abulizi A, Wen H, Shao Y, Aji T. Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11 years follow-up. BMC Surg 2021; 21:12. [PMID: 33407348 PMCID: PMC7789643 DOI: 10.1186/s12893-020-01028-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth. METHODS A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years. RESULTS Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group. CONCLUSIONS Double T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.
Collapse
Affiliation(s)
- Paizula Shalayiadang
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tiemin Jiang
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yusufu Yimiti
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bo Ran
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Aini
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ruiqing Zhang
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Guo
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ayifuhan Ahan
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abuduaini Abulizi
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Management of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, China.,WHO Collaboration Center on Prevention and Management of Echinococcosis, Clinical Medical Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Xinjiang Uyghur Autonomous Region Key Laboratory of Echinococcosis, Clinical Medical Institute, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yingmei Shao
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China.,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tuerganaili Aji
- Hepatobiliary and Echinococcosis Surgery Department, Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, #137 South Liyushan Road, Urumqi, 830054, China. .,Xinjiang Uyghur Autonomous Region Clinical Research Center for Echinococcosis and Hepatobiliary Diseases, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. .,Digestive and Vascular Surgery Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| |
Collapse
|
4
|
Yang X, Qiu Y, Wang W, Feng X, Shen S, Li B, Wen T, Yang J, Xu M, Chen Z, Yan L. Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis. Medicine (Baltimore) 2017; 96:e8774. [PMID: 29145333 PMCID: PMC5704878 DOI: 10.1097/md.0000000000008774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Postoperative bile leakage (BL) is a major complication of hepatic alveolar echinococcosis (HAE). The purpose of this study was to identify the risk factors for BL and to establish a simple scoring system for predicting BL.A total of 152 patients with HAE were included in the study between May 2004 and December 2016. The patient's baseline data, laboratory blood tests, imaging features, and surgical management were collected. Univariate and multivariate analyses were used to screen for factors to predict BL. The cutoff values for those factors and predictive value of a model were determined by receiver operative characteristic curve (ROC) analysis.BL was detected in 22 of the 152 patients. Univariate analyses showed significant differences in the lesion diameter, levels of lactate dehydrogenase (LDH), alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and direct bilirubin (DBIL), inferior vena cava invasion, surface area of hepatectomy, blood loss and history of percutaneous transhepatic cholangial drainage between patients with and without BL. On multivariate analyses, DBIL > 7.1 μmol/L, LDH > 194 U/L, lesion diameter > 12 cm and a larger surface area of hepatectomy were independent predictors of BL. The resulting area under the ROC of the scoring model was 0.724 (95% CI, 0.646-0.793).The lesion diameter, DBIL, larger surface area of hepatectomy, and elevated LDH were the important factors affecting the occurrence of BL after surgery. The risk score model will help the clinician to assess BL before surgery. More studies are needed to confirm the scoring model and risk factors.
Collapse
|
5
|
Mermi EU, Fidan N, Murat M. Focal Biliary System Obstruction and Atypical Liver Mass: Intrabiliary Ruptured Cyst Hydatid Case Report. Pol J Radiol 2017; 82:110-113. [PMID: 28344685 PMCID: PMC5338872 DOI: 10.12659/pjr.899073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/27/2016] [Indexed: 11/24/2022] Open
Abstract
Background Hydatid disease can involve any part of the body, but the liver is the most frequently affected organ. Intrabiliary rupture is one of the most serious complications of a hepatic hydatid cyst. Radiological findings, especially magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRI/MRCP), are helpful in the diagnosis of hydatid disease. Case Report We present a 48-year-old female patient with complaints of abdominal pain and jaundice. Radiological examination showed a heterogeneous lesion that contained cystic-solid components and millimetric calcifications in the liver. Adjacent intrahepatic bile ducts were dilated. Conclusions In geographical areas endemic for hydatid disease, cyst rapture into the bile ducts should be included in the differential diagnosis even in seronegative cases, although it is not typical for hydatid cyst to be found as a mass lesion in the liver on US in patients with right upper quadrant pain and jaundice.Detailed imaging by MRI/MRCP should be done.
Collapse
Affiliation(s)
- Esra Ummuhan Mermi
- Department of Radiology, Hitit University, Training and Research Hospital, Corum, Turkey
| | - Nurdan Fidan
- Department of Radiology, Hitit University, Training and Research Hospital, Corum, Turkey
| | - Muammer Murat
- Department of Radiology, Hitit University, Training and Research Hospital, Corum, Turkey
| |
Collapse
|
6
|
Mihmanli M, Idiz UO, Kaya C, Demir U, Bostanci O, Omeroglu S, Bozkurt E. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol 2016; 8:1169-1181. [PMID: 27729953 PMCID: PMC5055586 DOI: 10.4254/wjh.v8.i28.1169] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Echinococcus granulosus (E. granulosus) and Echinococcus multilocularis (E. multilocularis) infections are the most common parasitic diseases that affect the liver. The disease course is typically slow and the patients tend to remain asymptomatic for many years. Often the diagnosis is incidental. Right upper quadrant abdominal pain, hepatitis, cholangitis, and anaphylaxis due to dissemination of the cyst are the main presenting symptoms. Ultrasonography is important in diagnosis. The World Health Organization classification, based on ultrasonographic findings, is used for staging of the disease and treatment selection. In addition to the imaging methods, immunological investigations are used to support the diagnosis. The available treatment options for E. granulosus infection include open surgery, percutaneous interventions, and pharmacotherapy. Aggressive surgery is the first-choice treatment for E. multilocularis infection, while pharmacotherapy is used as an adjunct to surgery. Due to a paucity of clinical studies, empirical evidence on the treatment of E. granulosus and E. multilocularis infections is largely lacking; there are no prominent and widely accepted clinical algorithms yet. In this article, we review the diagnosis and treatment of E. granulosus and E. multilocularis infections in the light of recent evidence.
Collapse
|
7
|
Alan B, Kapan M, Teke M, Hattapoğlu S, Arıkanoğlu Z. Value of cyst localization to predict cystobiliary communication in patients undergoing conservative surgery with hydatid cyst. Ther Clin Risk Manag 2016; 12:995-1001. [PMID: 27366078 PMCID: PMC4913991 DOI: 10.2147/tcrm.s104400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The objectives of this study were to investigate the relationship between the segmental localization of liver hydatid cyst by computed tomography (CT) and the presence of cystobiliary communication (CBC) and to identify the risk factors for CBC. PATIENTS AND METHODS One hundred and eleven of 163 patients who underwent liver hydatid surgery between January 2011 and September 2014 were included in this study and analyzed retrospectively. The size, number, stage, and segmental and lobar localization of the cysts were investigated by CT. The presence of CBC and preoperative laboratory findings were recorded from operation notes. RESULTS CBC was more frequent in single large cysts. CBC was most commonly detected in segment 1 (50%), 8 (48.3%), 7 (41.2%), and 4 (40%). CBC was more frequent in the right lobe (40.4%) and Gharbi stage 3 (41.8%) and 4 (55.6%) lesions. There were no differences in CBC according to distance from the hilus. In addition, preoperative total bilirubin, direct bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) elevations were associated with higher CBC frequency (P<0.05). Cyst diameter, number of cysts, and ALP and GGT elevations were independent predictors of CBC presence. CONCLUSION The evaluation of hydatid cyst diameter, morphological stage, and segmental and lobar localization by abdominal CT and measurement of preoperative cyst diameter, number of cysts, and ALP and GGT values may predict the presence of CBC.
Collapse
Affiliation(s)
- Bircan Alan
- Department of Radiology, Dicle University, Diyarbakır, Turkey
| | - Murat Kapan
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Memik Teke
- Department of Radiology, Dicle University, Diyarbakır, Turkey
| | | | - Zülfü Arıkanoğlu
- Department of General Surgery, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| |
Collapse
|
8
|
Peker KD, Gumusoglu AY, Seyit H, Kabuli HA, Salik AE, Gonenc M, Kapan S, Alis H. Prevention of Postoperative Bile Leak in Partial Cystectomy for Hydatid Liver Disease: Tricks of the Trade. J Gastrointest Surg 2015; 19:2228-34. [PMID: 26438482 DOI: 10.1007/s11605-015-2970-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/24/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The presence of postoperative bile leak is the major outcome measure for the assessment of operative success in partial cystectomy for hydatid liver disease. However, the optimal operative strategy to reduce the postoperative bile leak rate is yet to be defined. METHODS Medical records of patients who underwent partial cystectomy for hydatid liver disease between January 2013 and January 2015 were reviewed in this retrospective analysis. All patients were managed with a specific operative protocol. The primary outcome measure was the rate of persistent postoperative bile leak. The secondary outcome measures were the morbidity and mortality rate, and the length of hospital stay. RESULTS Twenty-eight patients were included in the study. Only one patient (3.6 %) developed persistent postoperative bile leak. The overall morbidity and mortality rate was 17.8 and 0 %, respectively. The median length of hospital stay was 5 days. CONCLUSION Aggressive preventative surgical measures have led to low persistent bile leak rates with low morbidity and mortality.
Collapse
Affiliation(s)
- Kivanc Derya Peker
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey.
| | - Alpen Yahya Gumusoglu
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Hakan Seyit
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Hamit Ahmet Kabuli
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Aysun Erbahceci Salik
- Interventional Radiology, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Gonenc
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Selin Kapan
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| | - Halil Alis
- General Surgery, Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh, Tevfik Saglam Cad. No: 11, 34147, Bakirkoy, Istanbul, Turkey
| |
Collapse
|
9
|
Subadventitial cystectomy in the management of biliary fistula with liver hydatid disease. Acta Trop 2015; 141:223-8. [PMID: 24973496 DOI: 10.1016/j.actatropica.2014.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/03/2014] [Accepted: 06/17/2014] [Indexed: 12/21/2022]
Abstract
Biliary fistulas are the most common morbidity (8.2-26%) following hydatid liver surgery. The aim of this study was to evaluate the results of subadventitial cystectomy in the treatment of liver hydatid cyst associated with a biliocystic fistula. The medical records of 153 patients who underwent subadventitial cystectomy for a liver hydatid cyst between January 2006 and December 2010 were retrospectively reviewed. Cysts were located in the right lobe anterior segment 37 (24.2%) patients, right lobe posterior segment 59 (38.6%) patients, the left lobe in 26 (17.0%) patients, and both lobes in 6 (3.9%) patients. The surgical procedures performed were closed (non-incised) subadventitial total cystectomy in 74 patients (48.4%), open (incised) subadventitial total cystectomy in 30 patients (19.6%), and subadventitial subtotal cystectomy in 49 patients (32.0%). Biliocystic communication was found in 52 patients (34.0%), and 21 patients (13.7%) were treated with T-tube drainage. Two patients had performed biliodigestive anastomosis. Biliary fistula was detected in 9 patients after subtotal subadventitial cystectomy. Biliary fistulas closed spontaneously within 10 days and 61 days respectively and the amount of drainage varying between 50 and 400ml after the procedure. Postoperative complication and recurrence rates were 19.0% and 0.7%, respectively. The mortality rate was 0%. Subadventitial cystectomy should be the surgical treatment of choice for this disease because of its feasibility and low rates of recurrence, complications of the residual cavity, and incidence of associated biliary fistula.
Collapse
|
10
|
Yücesoy AN, Poçan S. Secondary gallbladder hydatidosis and nonfragmanted germinative membrane sourced obstructive jaundice caused by intrabiliary ruptured hepatic hydatid cyst (a case report): two rare complication of the intrabiliary ruptured hepatic hydatid cyst. Hepatobiliary Surg Nutr 2014; 3:209-11. [PMID: 25202699 DOI: 10.3978/j.issn.2304-3881.2014.07.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/16/2014] [Indexed: 12/21/2022]
Abstract
Intrabiliary rupture is the most frequently seen complication of the hepatic hydatid cysts. Obstructive jaundice can be seen as a complication of the intrabiliary ruptured hepatic hydatid cysts due to the migrated cystic content into bile ducts. In this study, we present two rare complications seen in a patient who has intrabiliary ruptured hepatic hydatid cyst. Obstructive jaundice and secondary gallbladder hydatidosis depending on to the intrabiliary ruptured hepatic hydatid cyst in a 58-year-old man patient were diagnosed and treated. A large choledochal nonfragmanted germinative membran was found in the choledochus as the reason of biliary obstruction. Hepatic hydatid cyst is a world-wide disease. Intrabiliary rupture must be kept in mind in the patients who has hepatic hydatid cyst and biliary tract problems.
Collapse
Affiliation(s)
- Ali Naki Yücesoy
- 1 General Surgery Department, 2 Radiodiagnostic Department, Batı Bahat Hospital, Istanbul, Turkey
| | - Süheyl Poçan
- 1 General Surgery Department, 2 Radiodiagnostic Department, Batı Bahat Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Rajan PS, Bansal S, Sathiyamurthy R, Palanivelu C. Triple communicating complicated hepatic hydatid cyst: an unusual presentation and laparoendoscopic management. BMJ Case Rep 2014; 2014:bcr-2013-202770. [PMID: 24591384 DOI: 10.1136/bcr-2013-202770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Echinococcal disease in humans had been widely reported in the literature for its unusual presentation and location. We discuss a rare case of suppurated left hepatic hydatid cyst with contaminant transdiaphragmatic rupture communicating into the right pleural cavity along with fistulisation of cyst into the left hepatic duct and stomach which is very rare according to our knowledge. A 65-year-old man presented to us with features of cholangitis and sepsis. Initial radiological investigations revealed multiloculated cystic mass in the left lobe of cirrhotic liver communicating with the left hepatic duct and extending to the right pleural cavity with dilated common bile duct. Endoscopic retrograde cholangiopancreatography confirmed the diagnosis yielding hydatid membranes with presence of transgastric fistula in the left hepatic duct and provided postoperatively continuous internal drainage. Old age, complicated cyst, compromised respiratory status, sepsis and cirrhotic liver precluded us to plan for conservative surgical approach (laparoscopic drainage of mediastinal contents) with successful outcome.
Collapse
Affiliation(s)
- Pidigu Seshiyer Rajan
- Department of Minimal Access and Interventional Endoscopy, Gem Hospital & Research Centre, Coimbatore, Tamil Nadu, India
| | | | | | | |
Collapse
|
12
|
Zeybek N, Dede H, Balci D, Coskun AK, Ozerhan IH, Peker S, Peker Y. Biliary fistula after treatment for hydatid disease of the liver: When to intervene. World J Gastroenterol 2013; 19:355-61. [PMID: 23372357 PMCID: PMC3554819 DOI: 10.3748/wjg.v19.i3.355] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 11/12/2012] [Accepted: 11/24/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid disease of the liver.
METHODS: Between January 2000 and December 2010, out of 301 patients with a diagnosis of hydatid cyst of the liver, 282 patients who underwent treatment [either surgery or puncture, aspiration, injection and reaspiration (PAIR) procedure] were analysed. Patients were grouped according to the presence or absence of postoperative biliary fistula (PBF) (PBF vs no-PBF groups, respectively). Preoperative clinical, radiological and laboratory characteristics, operative characteristics including type of surgery, peroperative detection of BF, postoperative drain output, morbidity, mortality and length of hospital stays of patients were compared amongst groups. Multivariate analysis was performed to detect factors predictive of PBF. Receiver operative characteristics (ROC) curve analysis were used to determine ideal cutoff values for those variables found to be significant. A comparison was also made between patients whose fistula closed spontaneously (CS) and those with intervention in order to find predictive factors associated with spontaneous closure.
RESULTS: Among 282 patients [median (range) age, 23 (16-78) years; 77.0% male]; 210 (74.5%) were treated with conservative surgery, 33 (11.7%) radical surgery and 39 (13.8%) underwent percutaneous drainage with PAIR procedure A PBF developed in 46 (16.3%) patients, all within 5 d after operation. The maximum cyst diameter and preoperative alkaline phosphatase levels (U/L) were significantly higher in the PBF group than in the no-PBF group [10.5 ± 3.7 U/L vs 8.4 ± 3.5 U/L (P < 0.001) and 40.0 ± 235.1 U/L vs 190.0 ± 167.3 U/L (P = 0.02), respectively]. Hospitalization time was also significantly longer in the PBF group than in the no-PBF group [37.4 ± 18.0 d vs 22.4 ± 17.9 d (P < 0.001)]. A preoperative high alanine aminotransferase level (> 40 U/L) and a peroperative attempt for fistula closure were significant predictors of PBF development (P = 0.02, 95%CI: -0.03-0.5 and P = 0.001, 95%CI: 0.1-0.4), respectively. Comparison of patients whose PBF CS or with biliary intervention (BI) revealed that the mean diameter of the cyst was not significantly different between CS and BI groups however maximum drain output was significantly higher in the BI group (81.6 ± 118.1 cm vs 423.9 ± 298.4 cm, P < 0.001). Time for fistula closure was significantly higher in the BI group (10.1 ± 3.7 d vs 30.7 ± 15.1 d, P < 0.001). The ROC curve analysis revealed cut-off values of a maximum bilious drainage < 102 mL and a waiting period of 5.5 postoperative days for spontaneous closure with the sensitivity and specificity values of (83.3%-91.1%, AUC: 0.90) and (97%-91%, AUC: 0.95), respectively. The multivariate analysis demonstrated a PBF drainage volume < 102 mL to be the only statistically significant predictor of spontaneous closure (P < 0.001, 95%CI: 0.5-1.0).
CONCLUSION: Patients with PBF after hydatid surgery often have complicated postoperative course with serious morbidity. Patients who develop PBF with an output < 102 mL might be managed expectantly.
Collapse
|
13
|
Symeonidis N, Pavlidis T, Baltatzis M, Ballas K, Psarras K, Marakis G, Sakantamis A. Complicated liver echinococcosis: 30 years of experience from an endemic area. Scand J Surg 2013; 102:171-7. [PMID: 23963031 DOI: 10.1177/1457496913491877] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Although declining, cystic echinococcosis is still a serious public health issue in Greece. This study evaluated the clinical features, management, and short-term outcome of patients with complicated liver echinococcosis. MATERIAL AND METHODS A total of 227 patients who were operated on for 322 echinococcal cysts of the liver were retrospectively evaluated. Patients were divided into those with complicated disease (53.7%) and those with noncomplicated disease (46.3%). Intrabiliary rupture (34.4%), cyst infection (32.7%), and their combination (24.5%) were the most common complications. Demographic characteristics, previous hydatid cyst surgery, cyst multiplicity and location, presenting symptoms and signs, types of complicated disease, operative procedures performed, postoperative complications, and hospital stay were assessed. RESULTS Patient demographics and cyst characteristics demonstrated no significant difference between the two groups. The complicated disease group had significantly more pronounced clinical presentations and higher postoperative morbidity. Choice of surgical procedure depended upon cyst location and surgeon preference. Both conservative and radical procedures were performed, supplemented with additional management of the biliary tree when indicated. CONCLUSIONS Complicated liver echinococcosis demonstrates several distinct features that differentiate it from the noncomplicated disease. Frequently severe clinical manifestations, complexity of surgical management, and the increased postoperative complications characterize complicated liver echinococcal disease.
Collapse
Affiliation(s)
- N Symeonidis
- Second Propedeutical Department of Surgery, School of Medicine, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | | | | | | |
Collapse
|
14
|
Lakshminarayan R, Anuradha C. Haemobilia--a rare presentation of intrabiliary hydatid disease. J Med Imaging Radiat Oncol 2012; 56:650-3. [PMID: 23210585 DOI: 10.1111/j.1754-9485.2012.02400.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Intrabiliary hydatid cysts have been known to cause complications. We report a rare case of calcified crumpled intrabiliary hydatid cyst causing massive haemobilia due to a hepatic artery pseudoaneurysm, an unusual complication of intrabiliary hydatid cyst. The patient was successfully treated by stenting of the pseudoaneurysm with overlapping stents.
Collapse
|
15
|
Is hepatic resection the best treatment for hydatid cyst? J Gastrointest Surg 2012; 16:2086-93. [PMID: 22903365 DOI: 10.1007/s11605-012-1993-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/06/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hydatid disease is a serious public health problem in endemic areas, and the management is controversial. Operative treatment is generally accepted especially in patients presenting complications. Our policy is to perform radical surgery and, whenever possible, anatomic hepatic resection. The purpose is to report our experience and results in the management of liver hydatid disease. METHODS Between January 1991 and December 2010, 97 patients were referred to our department for surgical treatment of hepatic hydatid cyst. Data were retrospectively reviewed. Patients were divided into three treatment groups: conservative surgery (CS), total pericystectomy (PC), and hepatic resection (HR). The main outcome measures were the mortality, morbidity, and recurrence rate. RESULTS Median patient age was 45 years (range, 30-56 years). A total of 105 hydatid cysts were treated. Radical surgery was performed in 85 patients: major HR in 43 patients, minor HR in 9, and total PC in 33. CS was performed in 12 cases. There were no postoperative deaths, and the overall morbidity was 20 %. Postoperative morbidity in the HR group was 20 %. Minor (Grade I/II) and major (Grade III/IV) complications were comparable between groups (p = ns). No statistical difference in duration of hospitalization was observed between the CS and the HR group. One patient in the HR group developed a recurrence. CONCLUSIONS The findings of this study suggest that surgical resection is not associated with much more postoperative and cyst cavity-related complications than the other groups. In addition, there was no mortality and a low recurrence rate.
Collapse
|
16
|
Ramia JM, Figueras J, De la Plaza R, García-Parreño J. Cysto-biliary communication in liver hydatidosis. Langenbecks Arch Surg 2012; 397:881-7. [PMID: 22374106 DOI: 10.1007/s00423-012-0926-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/13/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver hydatidosis is a severe health problem in endemic areas. Due to migration from these countries to other zones, now it is a worldwide problem. Liver hydatidosis can provoke many complications (abscess, fistula to adjacent organs, migration, etc.), but the most frequent and one of the most severe complication is the communication between the cyst and the biliary tree. AIM The aim of this study is to perform a review on the epidemiology, clinical features, diagnostic methods, and therapeutic options to treat the communication between the cyst and the biliary tree. RESULTS Due to the lack of randomized clinical trial or meta-analysis on this topic, we performed a classical review and included our personal algorithm. CONCLUSIONS The communication between the cyst and the biliary tree varies from a small communication to a frank intrabiliary rupture. The percentage of patients with the communication between the cyst and the biliary tree is not well known because there is no accepted definition. The therapeutic options are multiple and related to the size of the communication, the location of the cyst, and the experience of the hepatobiliary surgeon. ERCP is now an important tool for the treatment of the communication between the cyst and the biliary tree.
Collapse
Affiliation(s)
- J M Ramia
- Hepato-Bilio-Pancreatic Surgical Unit, Department of Surgery, Guadalajara University Hospital, Guadalajara, Spain.
| | | | | | | |
Collapse
|
17
|
Michalopoulos N, Laskou S, Papavramidis TS, Pliakos I, Kotidis E, Kesisoglou I, Papavramidis ST. Rupture of right hepatic duct into hydatid cyst. J Korean Med Sci 2012; 27:953-6. [PMID: 22876065 PMCID: PMC3410246 DOI: 10.3346/jkms.2012.27.8.953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 05/20/2012] [Indexed: 11/20/2022] Open
Abstract
Echinococcal disease can develop anywhere in the human body. The liver represents its most frequent location. Hepatic hydatid cysts may rupture into the biliary tract, thorax, peritoneum, viscera, digestive tract or skin. We report a rare case with rupture of the right hepatic duct into a hydatid cyst in a woman with known hydatid disease and choledocholithiasis. The increased intra-luminal pressure in the biliary tree caused the rupture into the adjacent hydatid cyst. The creation of the fistula between the right hepatic duct and the hydatid cyst decompressed the biliary tree, decreased the bilirubin levels and offered a temporary resolution of the obstructive jaundice. Rupture of a hydatid cyst into the biliary tree usually leads to biliary colic, cholangitis and jaundice. However, in case of obstructive jaundice due to choledocholithiasis, it is possible that the cyst may rupture by other way around while offering the patient a temporary relief from his symptoms.
Collapse
Affiliation(s)
- Nickolaos Michalopoulos
- 3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
BACKGROUND AND AIM A serious complication of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistulas is associated with high morbidity and mortality. We carried out a prospective study of endoscopic management of hydatid cysts communicating with bile ducts in 28 patients. METHODS Presence of biliary fistula was suspected by jaundice and/or persistent external biliary fistula after surgical excision and was confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Patients underwent endoscopic sphincterotomy, and either biliary stenting or nasobiliary drainage. Nasobiliary drains were removed when bile leakage stopped and closure of the fistula was confirmed by cholangiography; stents were removed after 4-6 weeks. RESULTS Of 120 patients with hepatic hydatid cyst seen over a 10-year period, 28 patients developed fistula between the hepatic hydatid cyst and intrahepatic bile ducts (right intrahepatic bile ducts in 20 patients, left intrahepatic bile ducts in eight patients). Nine of 28 patients had persistent external biliary fistula after surgery. Ten patients showed membranes in bile ducts on cholangiography. We carried out either sphincterotomy with insertion of a nasobiliary drain (n=6) or sphincterotomy with biliary stenting (n=22). In 10 patients, the membranes were removed from bile ducts during ERCP. Fistulas healed in all patients after a median time of 11 days (range 5-45 days) after endoscopic treatment. We were able to remove nasobiliary drainage catheters and stents 8-45 days after placement. CONCLUSIONS Endoscopic therapy is an effective mode of treatment for biliary fistulas complicating hepatic hydatid cyst.
Collapse
Affiliation(s)
- Barjesh C Sharma
- Department of Gastroenterology, G B Pant Hospital, New Delhi, India.
| | | | | |
Collapse
|
19
|
Treatment of complicated hepatic cystic hydatidosis with intrabiliary rupture by pericystectomy in combination with Roux-en-Y hepaticojejunostomy. ACTA ACUST UNITED AC 2012; 32:205-209. [DOI: 10.1007/s11596-012-0036-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Indexed: 01/14/2023]
|
20
|
Manterola C, Vial M, Sanhueza A, Contreras J. Intrabiliary rupture of hepatic echinococcosis, a risk factor for developing postoperative morbidity: a cohort study. World J Surg 2011; 34:581-6. [PMID: 20087590 DOI: 10.1007/s00268-009-0322-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM). METHODS This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who had clinical check-ups at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Principal outcome variable was "development POM," considered dichotomously. The exposure variable was the presence of IBR, analyzed dichotomously (present or absent) and according to the number of IBR (without, with one, and with two or more). The sample size was considered on the basis of a 95% confidence interval (95% CI), a power of 80%, a 1:2 ratio of patients without and with IBR, and a 10% proportion of POM in patients without IBR and 26% in patients with IBR. Descriptive statistics and bivariate and multivariate analyses were used. Relative risks (RR) and 95% CI were calculated. RESULTS The cohorts (median age of 42 years, 56.4% female, a median cyst diameter of 15 cm, and a follow-up of 118 months) were composed of 96 patients without IBR (38.1%) and 156 patients with IBR (61.9%). A morbidity rate of 17.1% was verified (9.4% in the group without IBR and 21.8% in the group with IBR [p = 0.011]). An adjusted RR of 3.4 (95% CI = 2.64, 4.18) was verified for the comparison of subgroups without IBR vs. with two or more IBR (p < 0.001). CONCLUSION The presence of two or more IBR constitutes a risk factor for developing POM in patients with HE.
Collapse
Affiliation(s)
- Carlos Manterola
- Department of Surgery, Universidad de La Frontera, M. Montt 112, Office 408, Temuco, Chile.
| | | | | | | |
Collapse
|
21
|
Sharma M, Mahadevan B. An unusual cause of jaundice in a tropical country. Intrabiliary rupture of hydatid cyst. Gastroenterology 2011; 140:e3-4. [PMID: 21110968 DOI: 10.1053/j.gastro.2010.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 01/08/2010] [Accepted: 01/14/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, UP, India
| | | |
Collapse
|
22
|
Diagnosis and management against the complications of human cystic echinococcosis. ACTA ACUST UNITED AC 2010; 4:394-8. [DOI: 10.1007/s11684-010-0180-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 11/09/2010] [Indexed: 01/14/2023]
|
23
|
Wani I, Bhat Y, Khan N, Mir F, Nanda S, Shah OJ. Concomitant Rupture of Hydatid Cyst of Liver in Hepatic Duct and Gallbladder: Case Report. Gastroenterology Res 2010; 3:175-179. [PMID: 27942301 PMCID: PMC5139739 DOI: 10.4021/gr215e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2010] [Indexed: 01/04/2023] Open
Abstract
Hydatid cyst liver rupture into the biliary tree may involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts or rarely the gallbladder. Rupture can be occult or frank. A frank intrabiliary rupture of hepatic hydatid cyst is a rare but serious event. The authors are reporting a case of concomitant rupture of hydatid cyst of liver into right hepatic duct and the gallbladder. A 50-year-old female patient who presented with acute cholangitis was confirmed as a case of intrabilary rupture on ultrasonography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. Rupture of hydatid cyst of liver in right hepatic and the gallbladder was confirmed on surgery. Suture repair of cystobiliary fistula, choledochoduodenostomy with cholecystectomy was done.
Collapse
Affiliation(s)
- Imtiaz Wani
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Younis Bhat
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Naveed Khan
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Farooq Mir
- Department of Radiodiagnosis, SKIMS Srinagar, Kashmir, India
| | - Saima Nanda
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| | - Omar J Shah
- Department of Surgical Gastroenterology, SKIMS Srinagar, Kashmir, India
| |
Collapse
|
24
|
Secchi MA, Pettinari R, Mercapide C, Bracco R, Castilla C, Cassone E, Sisco P, Andriani O, Rossi L, Grondona J, Quadrelli L, Cabral R, Rodríguez León N, Ledesma C. Surgical management of liver hydatidosis: a multicentre series of 1412 patients. Liver Int 2010; 30:85-93. [PMID: 19747191 DOI: 10.1111/j.1478-3231.2009.02116.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The management of hydatid liver disease (HLD) includes various nonsurgical and surgical treatment options. METHODS The purpose of the present longitudinal study was to report the changes in surgical management and the consequent outcome of HLD patients in 10 referral surgical centres in Argentina from 1975 to 2007. The study result analysis was divided into two study periods (1975-1990 and 1991-2007). RESULTS A total of 1412 patients underwent radical (Group 1: 396 patients), conservative (Group 2: 748 patients) or combined (Group 3: 536 interventions in 268 patients) surgical procedures. The overall mortality and complication rate (Clavien I-IV) was 1.8 and 39% respectively. The complication rate was significantly lower in Group 1 (26%) compared with Group 2 (45%) and Group 3 (42%) There was a significant decrease in mortality (2.3 vs. 1%), complication (42 vs. 34%) and early reoperation (12 vs. 6%) rates between the first study part (918 patients) and the second study part (494 patients). During a median follow-up of 7 years, there was a significant decrease in the first part of this study in the late reoperation rate (8.4-3%) and in disease recurrence (9-1.6%). CONCLUSION This large national observational multicentre series shows a significant improvement in surgical management of HLD in Argentina, with a decrease in mortality, morbidity, early and late reoperation and recurrence rates. A recent trend was observed in favour of an earlier diagnosis, less complicated clinical presentation and recent use of minimally invasive approaches.
Collapse
Affiliation(s)
- Mario A Secchi
- Department of Surgery, Hospital Italiano Garibaldi and Medical School IUNIR, Rosario, Argentina.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Asymptomatic occult cysto-biliary communication without bile into cavity of the liver hydatid cyst: a pitfall in conservative surgery. Int J Surg 2009; 7:387-91. [PMID: 19573629 DOI: 10.1016/j.ijsu.2009.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 06/20/2009] [Accepted: 06/24/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND An occult cysto-biliary communication in liver hydatid disease is still a major problem in surgical practice. Radiologic and intraoperative findings may not be helpful to detect cysto-biliary communications in some asymptomatic patients with liver hydatid disease. Biliary leakage is a troubling complication that arises after conservative surgery in patients who have occult "insidious" cysto-biliary communications. We aimed to identify the factors which are associated with the risk of occult insidious cysto-biliary communications in patients preoperatively who developed biliary leakage after surgery. PATIENTS AND METHODS We investigated the records of 183 asymptomatic patients treated for liver hydatid cyst and analyzed potential predictors of occult insidious cysto-biliary communication, retrospectively. RESULTS There were 115 female and 68 male patients; the mean age was 42.3 years. Occult insidious cysto-biliary communications which presented as postoperative biliary leakage found in 24 (13.1%). Independent clinical predictors were alkaline phosphatase >133 U/L, total bilirubin levels >1.2 mg/dL, white blood cell count >10,000/mm(3) and cyst diameter >10 cm on multivariate analysis. Seventeen of 24 were low output biliary fistula which resolved spontaneously within 9.2 days. The remaining 7 were high output biliary fistula for which endoscopic sphincterotomy was performed in all patients, fistulas resolved within 22.6 days. Average interval between endoscopic sphincterotomy and fistula closure was 10.3 days. Mean hospital stay was longer in patients with biliary leakage than in those without (9.8 vs. 4.2 day p<0.001). There was no hospital mortality. CONCLUSION The predictors demonstrated in this study should allow the likelihood of occult insidious cysto-biliary communication to be determined and, thus, indicate the need for additional procedures during operations to prevent the complications of biliary leakage.
Collapse
|
26
|
Prousalidis J, Kosmidis C, Kapoutzis K, Fachantidis E, Harlaftis N, Aletras H. Intrabiliary rupture of hydatid cysts of the liver. Am J Surg 2008; 197:193-8. [PMID: 18558386 DOI: 10.1016/j.amjsurg.2007.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 10/25/2007] [Accepted: 10/25/2007] [Indexed: 01/20/2023]
Abstract
BACKGROUND Intrabiliary rupture is a common and serious complication of hepatic hydatidosis, and its treatment remains controversial. METHODS Sixty-seven patients who underwent surgery for rupture of a hydatid cyst in the biliary tree were studied retrospectively. The following data were analyzed: age, sex, clinical presentation, and so on. RESULTS In 55 patients, intrabiliary rupture was diagnosed preoperatively and in 12 patients intraoperatively. In 51 patients, partial pericystectomy and closed-tube drainage followed. Pericystorraphy was performed in 9 patients. Omentoplasty was performed in 5 cases. After the meticulous cleansing of the common bile duct, T-tube drainage (60 patients), choledochoduodenostomy (4 patients), or sphincteroplasty (1 patient) was added. In 4 patients, there was a persisting external biliary fistula. The mean length of hospital stay was 18 days. Follow up (1-35 years) elicited 4 recurrences and 1 postoperative death. CONCLUSIONS Our results in intrabiliary rupture of echinococcal cysts are considered to be satisfactory. Surgical treatment can be improved with the modern methods of investigation, wider use of newer chemotherapeutics, and appropriate modification of surgical procedures.
Collapse
Affiliation(s)
- John Prousalidis
- A' Propedeutic Surgical Clinic, Aristotle's University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
27
|
Percutaneous treatment of hepatic hydatid cyst in pregnancy: long-term results. Arch Gynecol Obstet 2007; 277:547-50. [DOI: 10.1007/s00404-007-0498-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 10/16/2007] [Indexed: 12/22/2022]
|
28
|
Manouras A, Genetzakis M, Antonakis PT, Lagoudianakis E, Pattas M, Papadima A, Giannopoulos P, Menenakos E. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:249-53. [PMID: 17431515 PMCID: PMC2657701 DOI: 10.1155/2007/410308] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas. Endoscopic retrograde cholangiography with sphincterotomy has been successful as the sole and definitive means of treatment of intrabiliary ruptured hydatid cysts. A case of an elderly woman with frank rupture is presented, where the rupture was definitively managed endoscopically in conjunction with sphincterotomy to remove the intrabiliary obstructive daughter cysts and to achieve decontamination of the biliary tree. Endoscopic retrograde cholangiography provided an excellent diagnostic and therapeutic modality in the present case and, thus, it should be considered as definitive treatment in similar cases especially if surgical risk is anticipated to be high.
Collapse
Affiliation(s)
- Andreas Manouras
- First Department of Propaedeutic Surgery, Hippocrateion Hospital, Athens Medical School, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Ozaslan E. Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease. World J Gastroenterol 2006; 12:4930-1. [PMID: 16937486 PMCID: PMC4087638 DOI: 10.3748/wjg.v12.i30.4930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.
Collapse
|
30
|
Taori K, Sanyal R, Jawale R, Rathod J, Bhagat M. Intrabiliary hydatid without any focal liver lesion: a rare presentation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:397-8. [PMID: 16495503 DOI: 10.7863/jum.2006.25.3.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Kishor Taori
- Department of Radiodiagnosis, Government Medical College, Nagpur 440003, India.
| | | | | | | | | |
Collapse
|