ERCP treatment for intrabiliary rupture of hepatic hydatid cyst in a child

Abstract

In this report, we present a patient with intrabiliary rupture of a hydatid cyst, which caused choledochal obstruction and treated with endoscopic retrograde cholangiopancreatography (ERCP). It is an emergency and treated with mini- mally invasive surgery. A twelve-year-old female patient with acute upper ab- dominal pain, nausea, and vomiting was admitted to pediatric surgery clinic with the preliminary diagnosis of cholestasis. There were localized right upper abdominal rebound and tenderness. Contrast-enhanced axial computed tomog- raphy images through the liver showed that there was a cystic lesion in segment 4 communicating with the biliary system. The main hepatic duct was obliterat- ed and dilated by curvilinear densities consistent with germinative membranes expelled from the cyst into the biliary system. ERCP and sphincterotomy were performed. Germinative membrane and daughter cysts were cleaned with the use of balloon and basket. The patient is doing well without any other complica- tion 20 months after ERCP. There have been few case reports documenting the successful use of ERCP treatment of hydatid cyst. ERCP may be a useful pro- cedure in selected children with suspected intrabiliary rupture or common bile duct obstruction, which occurs due to daughter cyst and germinative membrane. 

Keywords

• Children
• Common bile duct
• Echinococcus granulosus
• ERCP
• Hydatid cyst