Cystic hepatic echinococcosis with intrabiliary rupture
A 43-year-old Tibetan female was brought to the department of general surgery with abdominal discomfort. Computed tomography (CT) scan revealed cystic hepatic echinococcosis in the right liver (Figure 1A). Further magnetic resonance cholangiopancreatography showed that there were cyst-biliary communications at right posterior bile duct, and several hydatid cysts inside common bile duct (Figure 1B, yellow arrow head showed rupture, white arrow heads showed bile duct hydatid cysts). Low confluence of right posterior bile duct to the common hepatic duct suggests biliary variation. Although serum total bilirubin was normal, serum alkaline phosphatase and gamma-glutamyl transpeptidase were elevated mildly with the value of 278 and 107 U/L respectively. She underwent right hemihepatectomy plus choledochoscopic hydatid cysts extraction through right posterior hepatic duct stump (Figure 1C, yellow arrow head showed right posterior bile duct stump, white arrow heads showed bile duct hydatid cysts). To prevent the spread of echinococcosis, we covered the surgical area with hypertonic saline gauze. A large number of hydatid cysts presented inside hepatectomy specimen that mixed with a lot of bile (Figure 1D). Hydatid cyst inside bile duct was removed completely, and postoperative recovery was smooth. We removed all the liver cysts, and no signs of any lesion residue in post-operative image. Administration of albendazole 400 mg, bis in die was started on the third day after operation to prevent recurrence, and she was advised to follow up every 3 months.
Acknowledgments
Funding: None.
Footnote
Provenance and Peer Review: This article was a standard submission to the journal. The article has undergone external peer review.
Peer Review File: Available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-40/prf
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-40/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from the patient for publication of this manuscript and any accompanying image resources.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
