VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Communicating biliary hydatid cyst with cholangitis: multimodal management
Figure 1. MRCP showing a multilocular hydatid cyst in the left hepatic lobe and material (vesicles) in the common bile duct (CBD).
A 41-year-oldman originating from Morocco was seen in the emergency department with epigastric pain appearing 5 days earlier. His medical history was insignificant. The patient was afebrile. Examination of the abdomen revealed tenderness in the right upper quadrant. Laboratory findings revealed a 2-fold increase of liver function test results and cholestasis (alkaline phosphatase [PAL]: 140 U/L [normal value, 53-128 U/L]). Bilirubin level was 1.6 mg/dL (normal value, !1.2 mg/dL) and C-reactive protein was 34 mg/L (normal value, !10 mg/L). On abdominal CT, a multiloculated 10-cm cyst was observed, evoking a hydatid cyst. Albendazole was started. During hospitalization, the patient had jaundice with elevation of bilirubin level and absolute eosinophil count. Magnetic resonance imaging showed common biliary duct dilatation along with intraductal material, suggesting daughter cyst migration. ERCP was performed with biliary sphincterotomy. Membranes were extracted, confirming daughter cyst migration. After ERCP, the bilirubin and eosinophil levels dropped to normal values. Surgery was performed 4 weeks after the beginning of albendazole treatment. Laparotomy was preferred over a laparoscopic approach because of a high probability of cystobiliary communication. Fenestration of the cyst was performed after extraction of daughter cysts
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and irrigation with hypertonic saline solution (20%). Injection of methylene blue from a catheter in the cystic duct confirmed cystobiliary communication. The outcome was favorable (Fig. 1; Video 1, available online at www. giejournal.org). DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Julian Cheron, MD, Medical Department, Georgios Katsanos, MD, Surgical Department, Pierre Eisendrath, MD, Jacques Devière, MD, PhD, Myriam Delhaye, MD, PhD, Marianna Arvanitakis, MD, PhD, Medical Department, Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
http://dx.doi.org/10.1016/j.gie.2015.01.048
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
Communicating biliary hydatid cyst with cholangitis: multimodal management
Figure 1. MRCP showing a multilocular hydatid cyst in the left hepatic lobe and material (vesicles) in the common bile duct (CBD).
A 41-year-oldman originating from Morocco was seen in the emergency department with epigastric pain appearing 5 days earlier. His medical history was insignificant. The patient was afebrile. Examination of the abdomen revealed tenderness in the right upper quadrant. Laboratory findings revealed a 2-fold increase of liver function test results and cholestasis (alkaline phosphatase [PAL]: 140 U/L [normal value, 53-128 U/L]). Bilirubin level was 1.6 mg/dL (normal value, !1.2 mg/dL) and C-reactive protein was 34 mg/L (normal value, !10 mg/L). On abdominal CT, a multiloculated 10-cm cyst was observed, evoking a hydatid cyst. Albendazole was started. During hospitalization, the patient had jaundice with elevation of bilirubin level and absolute eosinophil count. Magnetic resonance imaging showed common biliary duct dilatation along with intraductal material, suggesting daughter cyst migration. ERCP was performed with biliary sphincterotomy. Membranes were extracted, confirming daughter cyst migration. After ERCP, the bilirubin and eosinophil levels dropped to normal values. Surgery was performed 4 weeks after the beginning of albendazole treatment. Laparotomy was preferred over a laparoscopic approach because of a high probability of cystobiliary communication. Fenestration of the cyst was performed after extraction of daughter cysts
www.giejournal.org
and irrigation with hypertonic saline solution (20%). Injection of methylene blue from a catheter in the cystic duct confirmed cystobiliary communication. The outcome was favorable (Fig. 1; Video 1, available online at www. giejournal.org). DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Julian Cheron, MD, Medical Department, Georgios Katsanos, MD, Surgical Department, Pierre Eisendrath, MD, Jacques Devière, MD, PhD, Myriam Delhaye, MD, PhD, Marianna Arvanitakis, MD, PhD, Medical Department, Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
http://dx.doi.org/10.1016/j.gie.2015.01.048
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
