MANAGEMENT OF INTRABILIARY RUPTURE OF HYDATID CYST OF THE LIVER

Thirty-six patients with intrabiliary rupture of hepatic echinococcal cysts were managed between 1974 and 1993. Clinical findings, skin test s, serologic tests, and imaging techniques were used to establish the diagnosis. Twenty-five (69.4%) patients had pain, 24 (66.6%) jaundice, 22 (61.1%) fever, 20 (55.5%) chills, 10 (27.7%) malaise, and 7 (19.4% ) other symptoms as the major causes of admission. All patients underw ent choledochotomy and T-tube drainage. Treatment directed to the cyst was cystectomy and capittonage, cystectomy and drainage, and partial hepatectomy in 22, 12, and 2 patients, respectively. Omentoplasty was added to the treatment in 10 patients. Seven (19.4%) patients had comp lications. The period of hospitalization for patients with and without complications was 34.6 +/- 18.1 and 15.1 +/- 2.7, days, respectively. This study indicates that better results are obtained in patients wit h cystic lesions of the liver by avoiding percutaneous puncture or bio psy, the early use of ultrasonography and computed tomography, evacuat ion of the cyst together with its germinative membrane and the involve d biliary tract under adequate care to avoid spillage into the periton eal cavity, treating the remaining cavity according to its location, s ize, and the presence of infection, and decreasing the pressure in the biliary tract by T-tube drainage.