- Email: [email protected]
Hepatic Hydatid Cysts Causing Biliary Obstruction
Accepted Manuscript Hepatic Hydatid Cysts Causing Biliary Obstruction Antonio M. Caballero-Mateos, MD (Drafting of the manuscrit), Juan Gabriel Martínez-Cara, MD (Supervision), Eduardo Redondo-Cerezo, MD, PhD (Design and supervision)
PII: DOI: Reference:
S1542-3565(17)30012-5 10.1016/j.cgh.2017.01.001 YJCGH 55057
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 4 January 2017 Please cite this article as: Caballero-Mateos AM, Martínez-Cara JG, Redondo-Cerezo E, Hepatic Hydatid Cysts Causing Biliary Obstruction, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/j.cgh.2017.01.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Original Paper SHORT TITLE: Hepatic Hydatid Cysts Causing Biliary Obstruction
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Antonio M Caballero-Mateos, MD (Drafting of the manuscrit) Juan Gabriel Martínez-Cara, MD (Supervision)
SC
Eduardo Redondo-Cerezo MD, PhD (Design and supervision)
M AN U
Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital. Complejo Hospitalario Universitario de Granada. Granada. Spain Disclosure: The authors have no conflicts of interest. Key words: Cholangytis; Hydatid cyst; ERCP
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Corresponding author:
Antonio M Caballero Mateos, MD.
Endoscopy Unit. Gastroenterology and Hepatology Department.
EP
Virgen de las Nieves University Hospital.
AC C
Avenida de las Fuerzas Armadas 2. 18014 - Granada. Spain. Tel: +34-958020146
Email: [email protected].
ACCEPTED MANUSCRIPT Hepatic Hydatid Cysts Causing Biliary Obstruction
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A 66 year-old man was hospitalized with a 3-day history of upper right quadrant pain and jaundice. The patient described similar, recurrent episodes during the last 3 months. The physical examination revealed fever, an icteric sclera and tenderness at the upper right quadrant of the abdomen as well as the epigastric area; there was no rigidity or rebound tenderness. Laboratory tests showed a total serum bilirubin of 5.2 mg/dL (normal, 0.3-1.2); direct bilirubin, 4.3 mg/dL (normal, 0.1-0.4); aspartate aminotransferase, 84 U/L (normal, 545); alanine aminotransferase, 76 U/L (normal, 0-50); and serum alkaline phosphatase, 433 IU/L (normal, 25-230). The patient underwent an abdominal contrast-enhanced computed tomography (CT) and an Endoscopic retrograde cholangiopancreatography (ERCP) (Figures 13). Meanwhile he was managed with Piperacillin-tazobactam 4g each 6 hours iv.
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In this case, the CT observed hepatic hydatid cysts and intra and extrahepatic dilatation with multiple intraductal calcified filling defects (figure 1). ERCP with sphincterotomy was performed (Figures 2-3), showing one bigger and two smaller calcified cysts compressing the main hepatic ducts, and multiple calcified hydatid membranes where removed by balloon sweeping (Figure 4). The patient had an unremarkable recovery and was discharged on postoperative day 2. The treatment was changed to Cefuroxime-axetile 500mg each 12 hours for 5 days. 3 months later the patient remained asymptomatic.
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The communication between a cyst and the biliary tract is the most common complication of hepatic hydatid cyst (HHC). Communicating rupture consists of a tear of the endocyst with escape of cyst contents via biliary radicles that have been incorporated in the pericyst (1). This may lead to obstructive jaundice, pancreatitis, cholangitis, and sepsis with high mortality (2). Small cysto-biliary communications develop in 80-90% of all HHCs. Abdominal US, CT or Magnetic resonance imaging may detect the presence floating hydatid membranes inside the biliary tree or even cystobiliary fistulas
Lewall, D.B. and McCorkell, S.J. Rupture of echinococcal cysts: diagnosis, classification, and clinical implications. AJR Am J Roentgenol. 1986; 146: 391–394. 2) Jabbour N, Shirazi SK, Genyk Y, Mateo R, Pak E, Cosenza DC, Peyre CG, Selby RR. Surgical management of complicated hydatid disease of the liver. Am Surg 2002; 68: 984-988
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PII: DOI: Reference:
S1542-3565(17)30012-5 10.1016/j.cgh.2017.01.001 YJCGH 55057
To appear in: Clinical Gastroenterology and Hepatology Accepted Date: 4 January 2017 Please cite this article as: Caballero-Mateos AM, Martínez-Cara JG, Redondo-Cerezo E, Hepatic Hydatid Cysts Causing Biliary Obstruction, Clinical Gastroenterology and Hepatology (2017), doi: 10.1016/j.cgh.2017.01.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Original Paper SHORT TITLE: Hepatic Hydatid Cysts Causing Biliary Obstruction
RI PT
Antonio M Caballero-Mateos, MD (Drafting of the manuscrit) Juan Gabriel Martínez-Cara, MD (Supervision)
SC
Eduardo Redondo-Cerezo MD, PhD (Design and supervision)
M AN U
Department of Gastroenterology and Hepatology, “Virgen de las Nieves” University Hospital. Complejo Hospitalario Universitario de Granada. Granada. Spain Disclosure: The authors have no conflicts of interest. Key words: Cholangytis; Hydatid cyst; ERCP
TE D
Corresponding author:
Antonio M Caballero Mateos, MD.
Endoscopy Unit. Gastroenterology and Hepatology Department.
EP
Virgen de las Nieves University Hospital.
AC C
Avenida de las Fuerzas Armadas 2. 18014 - Granada. Spain. Tel: +34-958020146
Email: [email protected].
ACCEPTED MANUSCRIPT Hepatic Hydatid Cysts Causing Biliary Obstruction
RI PT
A 66 year-old man was hospitalized with a 3-day history of upper right quadrant pain and jaundice. The patient described similar, recurrent episodes during the last 3 months. The physical examination revealed fever, an icteric sclera and tenderness at the upper right quadrant of the abdomen as well as the epigastric area; there was no rigidity or rebound tenderness. Laboratory tests showed a total serum bilirubin of 5.2 mg/dL (normal, 0.3-1.2); direct bilirubin, 4.3 mg/dL (normal, 0.1-0.4); aspartate aminotransferase, 84 U/L (normal, 545); alanine aminotransferase, 76 U/L (normal, 0-50); and serum alkaline phosphatase, 433 IU/L (normal, 25-230). The patient underwent an abdominal contrast-enhanced computed tomography (CT) and an Endoscopic retrograde cholangiopancreatography (ERCP) (Figures 13). Meanwhile he was managed with Piperacillin-tazobactam 4g each 6 hours iv.
M AN U
SC
In this case, the CT observed hepatic hydatid cysts and intra and extrahepatic dilatation with multiple intraductal calcified filling defects (figure 1). ERCP with sphincterotomy was performed (Figures 2-3), showing one bigger and two smaller calcified cysts compressing the main hepatic ducts, and multiple calcified hydatid membranes where removed by balloon sweeping (Figure 4). The patient had an unremarkable recovery and was discharged on postoperative day 2. The treatment was changed to Cefuroxime-axetile 500mg each 12 hours for 5 days. 3 months later the patient remained asymptomatic.
EP
TE D
The communication between a cyst and the biliary tract is the most common complication of hepatic hydatid cyst (HHC). Communicating rupture consists of a tear of the endocyst with escape of cyst contents via biliary radicles that have been incorporated in the pericyst (1). This may lead to obstructive jaundice, pancreatitis, cholangitis, and sepsis with high mortality (2). Small cysto-biliary communications develop in 80-90% of all HHCs. Abdominal US, CT or Magnetic resonance imaging may detect the presence floating hydatid membranes inside the biliary tree or even cystobiliary fistulas
Lewall, D.B. and McCorkell, S.J. Rupture of echinococcal cysts: diagnosis, classification, and clinical implications. AJR Am J Roentgenol. 1986; 146: 391–394. 2) Jabbour N, Shirazi SK, Genyk Y, Mateo R, Pak E, Cosenza DC, Peyre CG, Selby RR. Surgical management of complicated hydatid disease of the liver. Am Surg 2002; 68: 984-988
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