Management of intrabiliary ruptured hydatid disease of the liver

Background/Aims: Intrabiliary rupture of hydatid cyst is an important compl ication of hydatid disease of the liver. The purpose of this study was to e valuate outcomes of patients with intrabiliary ruptured hydatid disease of the liver. Methodology: Two hundred and eleven patients were operated upon for hydatid cyst of the liver between 1990 and 1998 in our hospital. Twenty-four patie nts with intrabiliary rapture of hepatic hydatid cyst were retrospectively reviewed. Results: Diagnosis of hydatid cyst was principally made using ultrasonograp hy. We performed partial cystectomy + omentoplasty + transduodenal sphincte roplasty for 18 patients (75%). Daughter cysts and hydatid debris were foun d in common bile duct in 8 patients (33%). Internal opening of biliary fist ula was found in 21 patients (87.5%). Morbidity rate was 12%. One patient d ied of unrelated causes. The average postoperative hospitalization period f or the sphincteroplasty group was 7.6 days. Conclusions: Preoperative radiologic examination and laboratory values were not helpful to exclude an intrabiliary rupture of hydatid cysts in our pat ients. If bile stained cystic fluid is found, it is clear that a communicat ion between hydatid cysts and the biliary tree exist. Transduodenal sphinct eroplasty can be preferred in the management of intrabiliary ruptured hydat id disease because of short hospitalization, low morbidity, and ability to decompress intrabiliary pressure.