(1) Department of Surgery, Pt. BDS PGIMS Rohtak, India
(2) Department of Radiology, Pt. BDS PGIMS Rohtak, India
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The disruption of a major bile duct due to intra-biliary rupture of a large hydatid cyst at liver hilum is a potentially lethal condition. An early diagnosis and appropriate surgical intervention is life saving in these cases. Internal biliary drainage remains the only option since defect in the biliary track is usually large and primary repair is not feasible. Roux-en-Y cysto-jejunostomy is the standard recommended treatment in such cases. This report describes one such patient that was successfully treated by cysto-cholecystostomy, a procedure that has not been described earlier in the literature.
A 35 years old male was admitted with the diagnosis of hydatid cyst liver. CT scan of the abdomen revealed a large hydatid cyst in right lobe of liver near hilum that had ruptured into the biliary system. On exploration there was a 10 x 8 cm cystic mass in right lobe of liver at the hilum containing 400 ml thick bile stained inspissated hydatid material that was evacuated. On cleaning the cavity, bile was seen trickling from divided biliary openings due to destruction of intra-cystic part of right hepatic duct. Through a choledochotomy incision, a Kehr’s T-tube was placed into the common bile duct with its proximal limb reaching into the cyst cavity through divided right hepatic duct. The adjoining gallbladder was mobilized from the liver bed, a longitudinal incision was given on fundus of the gallbladder and side to side cysto-cholecystostomy was performed with interrupted 2-0 vicryl sutures. Post-operative period was uneventful. MR cholangiogram was done at six weeks that demonstrated patent cysto-cholecystostomy anastomosis with normal biliary radicles and shrunken cyst cavity. The T-tube was removed at six weeks.
The gallbladder can be used as a conduit for internal biliary drainage in cases of large hydatid cyst of liver lying at hilum with intra-biliary rupture by performing cysto-cholecystostomy. It is a simple, safe, quick, physiological and less technically demanding procedure in comparison to Roux-en-Y cysto-jejunostomy.