WHEN 20 YEARS POST EXCISION HEPATIC HYDATID CYST PRESENTED AS INTRABILIARY RUPTURE: AN UNUSUAL RECURRENCE OF AN OTHERWISE COMMON COMPLICATION

1. WHEN 20 YEARS POST EXCISION HEPATIC HYDATID CYST
PRESENTED AS INTRABILIARY RUPTURE: AN UNUSUAL
RECURRENCE OF AN OTHERWISE COMMON COMPLICATION
Dr Saumitra Barthwal, Dr Sandeep Moudgil, Dr Ravinder Kaur.
Department of Radiodiagnosis,
Government Medical College & Hospital, Chandigarh.

2. INTRODUCTION
• 49 year-old female presented to the surgery emergency with complaints of
epigastric and right upper quadrant pain and fever since 1 month.
• Past history of left hepatic hydatid cyst excision with capitonnage in the year
1998.
• Laboratory findings revealed increase in serum aspartate transaminase (524
IU/L) and alanine aminotransferase levels (383 IU/L), elevated bilirubin (4.2
mg/dl), and alkaline phosphatase (1042 IU/L).
• Ultrasound abdomen revealed a large complex cystic lesion with multiple
daughter cysts in the left lobe of liver suggestive of recurrent hydatid disease.
• Contrast enhanced CT (CECT) was performed to know the extent of disease.

3. Axial non contrast (A) and contrast enhanced (B) CT abdomen image shows a large
solid cystic lesion with multiple peripheral daughter cysts involving the left lobe of
liver. A focal peripheral rim of calcfication is seen (green arrow). Imaging findings are
likely suggestive of hepatic hydatid cyst.
A B

4. Coronal reformatted CECT abdomen shows the aforementioned cystic lesion
communicating with the left hepatic duct through a focal rent (green arrow) in its
right lateral wall suggestive intrabiliary rupture of hydatid cyst.

5. Axial contrast enhanced CT abdomen shows dilated common bile duct (white arrow) with upstream
dilatation of intrahepatic biliary radicles (green arrows)

6. FOLLOW UP
A B C
• Endoscopic retrograde cholangiopancretograpy (ERCP)
guided transduodenal sphincteroplasty was performed to
decompress biliary pressure.
• Elective excision of the cyst was done after the infection
subsided.