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Frank intrabiliary rupture in liver hydatidosis located in the hilar plate: a surgical challenge
Jose M Ramia1, Roberto De-la-Plaza, Jose Quiñónes
1Unidad de Cirugía Hepatopancreatobiliar, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
Background:
Frank intrabiliary rupture (FIR) is a severe complication that occurs in around 30% of patients with liver hydatidosis. When FIR is present, the contents of the cyst may pass into the common bile duct and cause a variety of complications. If the FIR is located in the hilar confluence, surgical repair is a challenge. Currently there are no data regarding its optimum treatment.
Material And Methods:
Between May 2007 and December 2012, we treated 59 patients with liver hydatidosis. Four patients, all women, with a mean age of 51.7 years, had hydatid cysts located between segments IVb and V and FIR affecting the hilar plate. In 3 cases, the initial clinical condition was obstructive jaundice. The fourth patient presented recurrence after having undergone two operations as a child.
Results:
In each patient a major hepatectomy was performed with hilar plate reconstruction (3 left and 1 right). Morbidity included mild biliary fistula (1 patient) and abdominal collection resolved by percutaneous drainage (1 patient). There was no mortality. During follow-up (47 months), no recurrences of the disease or biliary strictures were recorded.
Conclusions:
FIR is a severe complication of liver hydatidosis. When it is located in the hilar confluence, liver resection may be the best surgical option for definitive resolution of the problem.
