Nonsurgical Endoscopic Resolution of Hepatic Hydatid Cyst with Intrabiliary Rupture: A Case Series

Abstract One of the commonly encountered complications of hepatic hydatid cysts is cystobiliary communication, which is observed in 2% to 42% of cases. Presentations can range from nonspecific mild symptoms to jaundice, biliary colic, cholangitis, liver abscesses, pancreatitis, sepsis, and organ failure, often necessitating surgical intervention. Preoperative endoscopic drainage, in such cases, is intended to achieve biliary decompression in the presence of cholangitis, remove hydatid elements within the bile duct, and reduce the chances of postoperative biliary fistulae. The role of endoscopic management as a therapeutic option resulting in complete resolution is less reported. We describe our experience regarding the feasibility and outcome of an alternative method. This is a retrospective, single-center, case series of three patients with hepatic hydatid ruptured into the biliary tract, who presented with cholangitis. All three patients underwent endoscopic treatment consisting of endoscopic sphincterotomy, nasocystic biliary drainage, and biliary stenting. At a median follow-up of 18 months, imaging and cholangiography revealed a complete cure in all three patients. There were no complications related to the procedure. Endoscopic drainage can be a modality of definitive treatment for intrabiliary ruptured hepatic hydatid cysts in select groups of patients, thus avoiding the need for surgical interventions.