Endoscopic removal of biliary tree echinococcal cysts

Abstract

Liver echinococcal cysts typically present as asymptomatic masses. In many cases, the cyst may be ruptured into the gallbladder or the biliary tree and may present with symptoms of biliary colic, jaundice or anaphylaxis. The present case referrs to a liver echinococcal cyst ruptured into the biliary tree which led to jaundice and has been treated with ERC P. A 54 years-old female patient from a rural area, presented to the emergency department with right upper quadrant pain and jaundice. In her anamnestic the patient had a known echinococcal cyst in segment V of the liver. The cyst was diagnosed in a previous abdominal control due to a prior episode of cholecystitis 5 years ago. The biochemical and hematological screening revealed leucocytosis with elevated PMNs, transaminasemia and bilirubinemia.The echogram revealed dilation of the hepatic and the common bile duct that contained echogenic material without an acoustic shadow. An ERC P confirmed suspicion of secondary echinococcal cysts within the common bile duct and after sphincterotomy cysts were thoroughly removed by the use of an endoscopic balloon. In cases were echinococcal cyst ruptures into the biliary tree, operative treatment is not the only option. When no septic symptoms are present, ERC P and sphincterotomy could be the first choice in removing the echinococcal cyst debris from the
common bile duct.