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

Öz

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.

Anahtar Kelimeler

• Karaciğer kist hidatik,PAIR,Kavite enfeksiyonu,Bronkobilier fistül

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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