ERCP in Intr-abiliary rupture of liver hydatid cysts.

1. Dr.Mohamed Al-Shekhani.
Dr.Taha Al-Karbuli.
Dr.Ali Hussein Ali.
ERCP In the management of intrabiliary rupture of liver hydatid cysts.

3. [IBRH] IS NOT A RARE COMPLICATION OF OF
HYDATID DISEASE OF THE LIVER.
SURGERY UNTIL RECENTLY WAS THE ONLY
DEFINITIVE TREATMENT .
WITH THE INTRODUCTION OF ERCP
PREOPERATIVELY OR POSTOPERATIVELY THERE
WAS A GREAT REDUCTION IN THE OPERATIVE
COMPLICATIONS.
THERE ARE REPORTS IN WHICH THE ERCP WAS
THE SOLE TREATMENT OF THIS CONDITION .
THIS WAS THE MAIN AIM OF THE STUDY OF
THESE SERIES OF CASES.

4. 3 types of communications:
Occult one when the endocyst or cyst
content remain within the pericyst
Communicating type where the cystic
content spill in to the small biliary
canaliculi
Frank rupture with the content of the
cyst spilling to the biliary tract.

5. OBJECTIVE:
TO EVALUATE ROLE OF ERCP IN THE
MANAGEMENT OF CASES OF IBRH.

6. STUDY OF 16 CASES OF IBRH
MANAGED BY ERCP.

7. SETTING:
THE ERCP UNIT OF KURDITAN CENTER
FOR GASTROENTEROLOGY &
HEPATOLOGY- ASULAIMANEYAH-IRAQI
KURDISTAN-IRAQ.
MAIN OUTCOME MEASUREMENTS:
IMPROVEMENT IN THE SYMPTOMS,
OBSTRUCTIVE LIVER FUNCTIONS
PATTERN & ULTRASONIC FINDINGS IN
THESE PATIENTS FOLLOWING ERCP
MANAGEMENT.

8. METHODS:
FROM 2007 -2010 :
16 CASES , AGES 10-79 YEARS.
PATIENTS WERE FOLLOWED UP CLINICALLY +
LAB INVESTIGATIONS , (US) , (CT) OR MRI
(WHEN AVAILABLE) , BEFORE AND AFTER
ERCP, SOME PATIENTS WERE CONTACTED
VIA MOBILE PHONE FOR FOLLOW-UP.

9. METHODS:
ERCP INCLUDED CLEARANCE OF THE
RETAINED HYDATID MEMBRANES IN CBD
WITH ENDOSCOPIC SPHICTEROTOMY PLUS
PLASTIC STENT INSERTION TO FACILITATE
DRAINAGE OF REMAINING HYDATID
CONTENTS, WHICH WAS REMOVED 3
MONTHS AFTER THE PROCEDURE.

10. RESULTS:
MALES>FEMALES(58% VS 42%)
MOST WERE FROM 30-50 YEARS.
THE PRESENTATION WAS FEVER, JAUNDICE,
ITCHING & RIGHT HYPOCHONDRIAL PAIN IN
MOST PATIENTS.
THE LIVER FUNCTION TESTS WERE
OBSTRUCTIVE PATTERN WITH ELEVATED
DIRECT BILIRUBIN & ALKHALINE
PHOSPHATES IN MOST PATIENTS.
THE TUS REVEALED DILATED COMMON BILE
DUCT & SINGLE LIVER CYST IN MOST
PATIENTS & 2 OR 3 CYSTS IN OTHERS.

11. RESULTS:
THE ERCP MANAGEMENT LED TO
IMPROVEMENT IN CLINICAL, LABORATORY &
ULTRASONIC FINDINGS IN 8 PATIENTS & IN
THESE 8 PATIENTS ERCP WAS THE ONLY
PROCEDURE NEEDED PROVED BY FOLLOWUP OF THESE PATIENTS FOR 1 YEAR IN 6
PATIENTS & 2 YEARS IN THE OTHER 2
PATIENTS & SURGERY WAS NEEDED IN 7
CASES & ONE PATIENT DIED BECAUSE OF
SEPSIS.

12. CONCLUSIONS:
ERCP IS AN IMPORTANT
MANAGEMENT STRATEGY FOR
PATIENTS WITH IBRH WHICH CAN
LEAD TO CLINICAL, LAB & ULTRASONIC
IMPROVEMENTS & CAN BE THE ONLY
REQUIRED PROCEDURE IN AROUND
50% OF CASES

21. THANKS
What’s Your Message?