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Canadian Journal of Gastroenterology
Volume 21, Issue 4, Pages 249-253
Brief Communication

Endoscopic Management of a Relapsing Hepatic Hydatid Cyst with Intrabiliary Rupture: A Case Report and Review of the Literature

Andreas Manouras, Michael Genetzakis, Pantelis T Antonakis, Emmanuel Lagoudianakis, Michael Pattas, Artemisia Papadima, Panagiotis Giannopoulos, and Evangelos Menenakos

Hippocrateion Hospital, Athens Medical School, Athens, Greece

Received 15 March 2006; Accepted 6 June 2006

Copyright © 2007 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas.

Endoscopic retrograde cholangiography with sphincterotomy has been successful as the sole and definitive means of treatment of intra-biliary ruptured hydatid cysts. A case of an elderly woman with frank rupture is presented, where the rupture was definitively managed endoscopically in conjunction with sphincterotomy to remove the intrabiliary obstructive daughter cysts and to achieve decontamination of the biliary tree.

Endoscopic retrograde cholangiography provided an excellent diagnostic and therapeutic modality in the present case and, thus, it should be considered as definitive treatment in similar cases especially if surgical risk is anticipated to be high.