33rd Annual Congress of Turkish Pediatric Surgical Association

MH Okur, H Zeytun, B Aydoğdu, E Basuguy, S Otçu

Dicle University Medical Faculty Department of Pediatric Surgery

INTRODUCTION  

Hydatid disease, although rare, is still endemic in many countries, representing an important public health problem such as the Mediterranean region. Hydatid cysts of the liver exert pressure on the surrounding parenchyma, and in approximately one-fourth of the cases, due to higher pressure in the cyst, the cysts eventually leak into small bile ducts or perforate into large ones. Intrabiliary rupture can occur with two different clinical settings which are followed by certain symptoms. These are occult communication and apparent intrabiliary rupture. We present a case of a hydatid cyst of the liver which ruptured spontaneously into the common bile duct resulting in jaundice and cholangitis that treated on emergency.

CASE REPORT

A 13-year-old female patient was admitted with a 5 days history of painful progressive jaundice. Her liver was not palpable, leucocyte count 10.2x 103/L. Biochemical values were total bilirubin: 7 mg/ dL, conjugated bilurubin: 5.5 mg/dl, aspartate aminotransferase: 61 IU/L, alanine aminotransferase: 106 IU/L, LDH: 324 IU/L, GGT:469IU/L. Abdominal ultrasonography showed a cystic lesion of 13 x 12 cm in size located in the intraparenchymic hydatid cyst type and dilated intrahepatic and common bile duct (3.3 cm)

Computed Tomography scan revealed intraparenchymic hydatid cyst type IV(segments 7,8 and 5th segments) that opened totally into common bile duct and also showed dilated proximal and narrowed distal choledochal bile ducts (Figure 1). Patient under went right subcostal laparotomy was performed. The cyst was seen to communicate inferiorly with common hepatic duct in the region of ductal confluence with extension of the hydatid membranes into common hepatic duct and proximal common bile duct withupstream dilatation of the right and left hepatic ducts and intra-hepatic biliary radicles with ruptured membranes present, the right intrahepatic duct was seen communicating with cyst cavity. the cyst was opened, germinative membrane was extracted, cystectomy and drainage, omentopexy were performed,  was cleaned common bile duct through right hepatic duct and then right hepatic duct repaired the postoperative period was unremarkable and patient was discharged on day 7.

CONCLUSİON

Frequent common complication of hydatid hepatic cyst disease is rupture into the biliary tree. it is usually leads to biliary colic, cholangitis and jaundice. Accurate diagnosis and emergency 

MH Okur, H Zeytun, B Aydoğdu, E Basuguy, S Otçu

Dicle Üniversitesi Tıp Fakültesi Çocuk Cerrahisi AD

GIRIŞ

Hidatik hastalık hernekadar nadir olsada hala akdeniz bölgesinde endemik halk sağlığı problemidir. Karaciğer hidatik kisti olan vakaların  dörte birinde yüksek basınçtan dolayı sonunda küçük veya büyük olan safra yollarına sızar veya perfore olur. Inrabiliyer rüptür iki farklı klinik oluşturabilir, bunlar gizli olarak semptom vermez veya aşikardir. Biz bu çalışmada koledoğa spontan rüptüre olmuş ve sarılık ve kolanjite neden olan acil tedavi ettiğimiz karaciğer kist hidatiği vakasını sunduk.

VAKA SUNUMU

13 yaşında kız hasta 5 gündür mevcut ağrılı ve ilerleyen sarılık şikayeti ile başvurdu. Karaciğeri palpabl değildi, leukosit 10.2x 103/L. Biokimyasal değerleri Total bilirubin: 7 mg/ dL, direkt bilurubin: 5.5 mg/dl, aspartate aminotransferaz: 61 IU/L, alanine aminotransferaz: 106 IU/L, LDH: 324 IU/L, GGT:469IU/L idi. Abdominal ultrasonografi’de 13x12 cm boyutunda intraparankimal kistik lezyon ve dilate intrahepatik safra kanalları ve koledok saptandı (3.3 cm). Bilgisayarlı tomografi ile yapılan görüntülemede; koledoğa açılan ve koledoğun distalinde daralmaya proksimalinde dilatasyona neden olan intraparankimal tip IV hydatik kist (segment 5, 7, 8) olduğu saptandı. Hastaya sağ subkostal laparotomi yapıldı. Kistin inferiordan sağ hepatik kanal vasıtası ile koledoğa uzanan membranlar mevcuttu, sağ hepatik safra kanalı ile kist kavitesinin ilişkili olduğu görüldü. Kist açıldı germinatif membran çıkarıldı, kistektomi ve drenaj yapıldı, sağ hepatik safra kanalından ilerlenip dilate koledok temizlendi sağ hepatik safra kanalı onarıldı, omentopeksi yapıldı. Ameliyat sonrası hasta 7. gün sorunsuz olarak taburcu edildi.

SONUÇ

Karaciğer kist hidatiklerinin sık görülen komplikasyonu biliyer sisteme rüptürüdür. Genellikle biliyer kolik, kolanjit ve sarılığa neden olur. Eğer karaciğer hidatik kistinin biliyer sistem ile belirgin ilişkisi varsa doğru tanı ve acil müdahale zorunludur