Thoracic rupture of hepatic hydatidosis (123 cases)

Hydatid disease is frequently endemic in countries with poor environmental sanitation and in geographic areas where interaction between humans and animals is common. Pulmonary complications result from the proximity of hydatid cysts in the liver and the diaphragm.

The medical records of 123 patients, with established hydatid disease manifesting abnormal chest roentgenograms, were retrospectively analyzed for the period January 1990 to December 1999.

Chest roentgenogram and abdominal ultrasound provided a correct preoperative diagnosis in 108 patients (87.8%). Expectoration of bile, demonstration of fistula by ultrasound, expectoration of cyst contents, and additional ultrasound or imaging findings were the criteria used to establish the preoperative diagnosis. The remaining 15 cases were confirmed at operation. Men outnumbered women nearly 3:1. Mean age was 36.2 years. Pulmonary resection was performed in 67 cases. Sixty-eight patients presented with a bronchobiliary fistula (55.3%). Morbidity rate was 14.6% and mortality rate was 8.9%.

Thoracotomy offers adequate simultaneous access to both the chest and hepatic lesions with acceptable morbidity and mortality. Endoscopic sphincterotomy undertaken preoperatively is useful in reducing biliary complications.