Intrabiliary rupture of a hepatic hydatid cyst - Associated clinical factors and proper management

Hypothesis: The prediction of an intrabiliary rupture of a hepatic hydatid cyst using associated clinical factors is important for early diagnosis and proper management. Design: Case series of patients with hepatic hydatid cysts treated between January 1, 1992, and January 1, 2000, in a single institution. Setting: A tertiary care teaching hospital. Patients: The clinical findings in 116 patients with a hepatic hydatid cyst were reviewed. Of the 116 pati ents, 24 (21%) had a cyst-biliary communication: 15 (13%) had an occult rup ture, and 9 (8%) had a frank rupture. Main Outcome Measures: The following variables were analyzed as potential p redictors of an intrabiliary rupture: age, Sex, type and duration of sympto ms, findings on physical examination, leukocyte count, liver function test results, serologic test results, suggestive ultrasonographic findings, ultr asonographic cyst features (type, diameter, number, and localization), and whether the cyst is primary or recurrent. Results: The independent clinical factors for the presence of an occult rup ture were a history of nausea and vomiting (P = .004), alkaline phosphatase level greater than 144 U/L (P = .004), total bilirubin level greater than 0.8 mg/dL (> 13.5 mu mol/L) (P < .001), and cyst diameter greater than 14.5 cm (P < .001) in multivariate analysis. Multivariate analysis also showed that history of jaundice (P < .001), jaundice found on physical examination (P = .05), cyst diameter greater than 10.5 cm (P = .009), a type IV cyst ( P < .001), and suggestive ultrasonographic findings (P < .001) were the ind ependent clinical predictors for the presence of a frank intrabiliary ruptu re. Patients with cyst-biliary communications had increased morbidity rates (13 [54%] of 24 patients vs 13 [14%] of 92 patients; P < .001) and longer mean postoperative hospital stays (13.7 vs 9.4 days; P = .03) compared with others. Conclusion: Clinical predictors should be considered for early diagnosis an d proper management of intrabiliary ruptures in patients with hepatic hydat id cysts.