Jssn Vol 17 No1_final to print copy.pdf


31JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Management of cysto-biliary communication in hydatid 

cyst of liver

Bhattarai A, Kandel BP, Ghimire B, Kansakar P, Lakhey PJ, Vaidya P, Singh KP 

Correspondence: 

Abstract

Introduction: Biliary communication of hepatic hydatosis is one of the important complications. It 

mortality.

Methods:
th th

Results:

during operation and managed with suture plication and omentopexy. Out of the eight major 

communications, seven were diagnosed preoperatively and all had cholangitis, and one had hydatid 

evacuation of cyst content and stenting. one case was managed with pigtail drain as the patient had 

Conclusion:

Therapeutic options are related to size and location of the cyst and size of communication.

Keywords

Introduction 

literature, only four species are clinically important. 

involvement is seen in two third of the cases. It is one 

communication of the hydatid cyst is one of the most 

common and serious complication of the hydatid cyst of the 

liver. Communications either due to increased intracystic 

duct due to cyst.1 Rarely hydatid cyst ruptures into the 

peritoneal cavity, pleural cavity and pericardial cavity.

1

2

Original Article



32JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

2

duodenum, present as CBC, whereas after surgery the 
2,3

3

CBC pre-operative ultrasound, CT scan and MRI may 

of the cases.

If CBC remains undetected or unrepaired during 

is important to diagnose and treat CBC in the preoperative 

and intraoperative period.

There are several factors that can predict CBC. These 

 Other factors 

cm, cyst located at the center of the liver and near hilum, 

advance stage of the cyst, multivescicular cyst are also 

independent predictor of CBC. 

Surgery is the mainstay of the treatment for the hepatic 

the management of hepatic hydatid cyst and CBC. Several 

site of communication, size of communication, experience 

of the surgeon, general condition of the patient and status 

In this study we review the demography, clinical feature, 

communication (CBC) in our institute.

Methods

and patients who were diagnosed and treated for hepatic 

hydatid cyst with CBC were included in this study. 

Result

hydatid cyst. Thirteen patients were diagnosed as CBC. 

were minor CBC.

presentation and it was present in all cases. Seven patients 

jaundice and cholangitis whereas one patient with hydatid 

patients with major CBC whereas only mild derangement 

infection was present in 3 cases.

complex surgery and need of repeated intervention. One 

Table 1.Surgical procedure done for major CBC

Interventions done
No of 

patients

exploration
2

1

stenting

2

1

1

Pigtail drain 1



33JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Surgical site infection (SSI) was the most common 

Table 2.Total no. of complications 

Types of complications No of patients

SSI

3

Chest infection 2

1

CECT abdomen shows hydatid cyst of gall bladder                     

CECT hydatid cyst with CBC

Discussion

hydatid cyst surgery.3

CBC after surgery.

literature. Pre-operative diagnosis of minor CBC was 

rest was normal during clinical and radiological examination 

whereas in major CBC most of the patients presented with 

hydatid cyst of liver with right sided hypochondrial pain 

suspected to have CBC.2

in our study, whereas in some literature shows involvement 
8 But in 

contrast to other studies, incidence of major CBC is high 

 This is due to most 

of the cases were referred from the other center for further 

management.

3, 11

2

sphincterotomy is considered the procedure of choice to 

decrease the rate of surgical reinterventions.8  In a study 

to heal.12



JSSN Journal of Society of Surgeons of Nepal

JSSN 2014; 17 (1)

Conclusion

of hydatid cyst of liver. Therapeutic options are related to 

size and location of the cyst, size of communication and 

more complex procedures.

References

1.

Langenbecks Arch Surg. 

2012 Aug;397(6):881-7.

2.

in the treatment of controversial complication of 

3.

hepatic hydatid cyst surgery in Basrah. Bas J Surg. 

of hydatid cysts into the liver with reference to 

8.

cholangiopancreatography in the management of 

9.

C. Management of liver hydatid cysts with a large 

11.

12.