Intrabiliary rupture of hepatic hydatid cyst presenting as acute pancreatitis and treatment with endoscopic sphincterotomy: report of two cases

Abstract

We describe the cases of two young patients, one 16 year
old male and one 21 year old female, who presented acute
pancreatitis as a complication of intrabiliary rupture of
hepatic hydatid cysts. Both patients underwent diagnostic
and therapeutic endoscopic retrograde cholangiopancreatography
with endoscopic sphincterotomy and extraction
of hydatid material from the common bile duct by balloon
and basket catheters, which resulted in prompt resolution
of pancreatitis. We were able to discharge both patients five
days after the procedure. They were prescribed three cycles
of albendazole and have since been free of symptoms for
two and one years, respectively. There are 16 previous case
reports in the international medical literature of acute pancreatitis
as a complication of hepatic hydatid disease ruptured
into the biliary tree, but only 3 reports of treatment
with endoscopic sphincterotomy. This case study suggests
that physicians should be aware of this entity in endemic
areas, and it indicates that endoscopic sphincterotomy is
safe and effective in the treatment of acute pancreatitis induced
by intrabiliary rupture of hepatic hydatid disease.
However, surgical resection remains the generally accepted
method of radical treatment for hepatic hydatid disease.
Key words: Hepatic hydatid disease, endoscopic sphincterotomy,
acute pancreatitis.