Perkütan kist hidatik tedavisi sonrasi apse ve bronko-bilier fistül: Olgu sunumu

Year 2020, Volume: 4 Issue: 1, 105 - 107, 02.01.2020

Ercan Korkut Nurhak Aksungur Gürkan Öztürk

https://doi.org/10.28982/josam.616064

Cited By: 1

Abstract

Hepatik kist vakalarının çoğu komplike olmayan klinik seyir ve tedavi göstermektedir. Perkütan müdahale edilen kistlerde, kist içerisindeki basıncın düşmesi ile gizli olan safra fistülleri kavite içerisine drene olabilir ve kist komplike hale gelebilir. Komplike hale gelmiş olan kistler non invaziv ve minimal invaziv yöntemlerle takip ve tedavi edilebilir. Ancak kistin yerleşim yeri, büyüklüğü ve hastanın yaşadığı yer göz önünde bulundurularak yakından takip edilmesi gerekir. Perkütan müdahale edilen ve apse gelişmiş kist hidatiklerde cerrahi tedavide geç kalmak, yüksek morbidite ve mortalite oranlarına neden olmaktadır. Karaciğer sağ lopta 150x110 mm ebadında Gharbi tip 1 kist hidatik lezyonu olan hastaya ultrasonografi eşliğinde PAIR (puncture – aspiration – injection – respiration) yapılmıştı. Kistin safra yolları ile iştirakli olması üzerine perkütan kateter takılmış ve endoskopik retrograd kolanjiopankreatografi (ERCP) yapılmıştı. Takiplerinde kavite enfeksiyonu gelişmesi üzerine açık cerrahi drenaj yapılan, ameliyattan sonra bronko-bilier füstül ve pnömoni gelişen Kist hidatik olgusu sunulmuştur. Perkütan tedaviye bağlı kavite enfeksiyonu gelişen hastaların, hastanede kalış süresi, tedavi maliyetleri ve hastalığın morbiditesi açık cerrahi yapılan hastalara göre daha kötü sonuçlara yol açmaktadır. Kavite enfeksiyonu gelişen hastaların yakın takip edilmesini ve gecikmeden cerrahi işlem yapılmasının daha uygun olduğunu düşünüyoruz.

Keywords

Karaciğer kist hidatik, PAIR, Kavite enfeksiyonu, Bronkobilier fistül

Abscess and bronchobiliary fistula following percutaneous hydatid cyst treatment: A case report

Abstract

Clinical course and treatment are uncomplicated in majority of hepatic hydatid cyst cases. However, in hydatid cysts involving percutaneous intervention, occult biliary fistulas can drain into the cavity due to a decrease in intracystic pressure, and the cyst can become complicated. Complicated cysts may be treated using non- invasive and minimally invasive methods. The cyst must be closely observed in terms of its size and location and the patient’s place of residence. Delayed surgical treatment of hydatid cysts with percutaneous intervention and abscess development leads to high morbidity and mortality. Ultrasonography-guided PAIR (puncture – aspiration– injection – respiration) was performed on a patient with a Gharbi type 1 hydatid cyst, 150x110 mm in size, located in the right hepatic lobe. Since the cyst was contiguous with the bile ducts, a percutaneous catheter was inserted and endoscopic retrograde cholangiopancreatography (ERCP) was performed. We report a case of hydatid cyst involving open surgical drainage following cavity infection and postoperative bronchobiliary fistula and pneumonia at follow-up. Patients developing percutaneous treatment-related cavity infection have worse hospital stays, treatment costs, disease-related morbidity and mortality than those undergoing open surgery. We think that patients developing cavity infection should be closely observed and that the surgical procedure should be performed without delay.

Keywords

Hydatid cyst of the liver, PAIR, Cavity infection, Bronchobiliary fistula

References

• 1. Yazar S, Ozkan AT, Hokelek M, Polat E, Yilmaz H, Ozbilge H, et al. Cystic echinococcosis in Turkey from 2001-2005. Turkiye Parazitolojii Dergisi. 2008;32(3):208-20.
• 2. Belhaj A, Ouazzani E-T, Majdoub KI, Toughrai I, Laalim SA, Mazaz K. Anaphylactic shock during splenic hydatid cyst surgery: A case report. J Surg Med. 2018;2(2):154-6.
• 3. Nabarro LE, Amin Z, Chiodini PL. Current management of cystic echinococcosis: a survey of specialist practice. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2015;60(5):721-8. doi: 10.1093/cid/ciu931.
• 4. Kabaalioglu A, Ceken K, Alimoglu E, Apaydin A. Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice? European Journal of Radiology. 2006;59(1):65-73. doi: 10.1016/j.ejrad.2006.01.014.
• 5. Nayman A, Guler I, Keskin S, Erdem TB, Borazan H, Kucukapan A, et al. A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience. Diagnostic and Interventional Radiology (Ankara, Turkey). 2016;22(1):47-51. doi: 10.5152/dir.2015.15011.
• 6. Bakdik S, Arslan S, Oncu F, Tolu I, Eryilmaz MA. Percutaneous treatment of hepatic cystic echinococcosis: the success of alcohol as a single endocavitary agent in PAIR, catheterization, and modified catheterization techniques. La Radiologia Medica. 2018;123(2):153-60. doi: 10.1007/s11547-017-0820-0.
• 7. Dolay K, Akbulut S. Role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease. World Journal of Gastroenterology. 2014;20(41):15253-61. doi: 10.3748/wjg.v20.i41.15253.
• 8. Nasseri-Moghaddam S, Abrishami A, Taefi A, Malekzadeh R. Percutaneous needle aspiration, injection, and re-aspiration with or without benzimidazole coverage for uncomplicated hepatic hydatid cysts. The Cochrane database of systematic reviews. 2011(1):Cd003623. doi: 10.1002/14651858.CD003623.pub3.
• 9. Suat Eren MK. Perkütan Karaciğer Kist Hidatik Tedavisi. Trd Sem. 2015;2015;(3):227–36.
• 10. Marija Stojkovic BGaTJ. Echinococcosis. Twenty-Third Edition ed. Manson's Tropical Diseases, editor: Elsevier; 2014.