Poster - 199
A RARE CAUSE OF THE COMMON BILE DUCT OBSTRUCTION; LIVER HYDATID CYST RUPTURE
MH Okur, H Zeytun, B Aydoğdu, E Basuguy, S Otçu
Dicle University Medical Faculty Department of Pediatric Surgery
INTRODUCTION
Hydatid disease, although rare,
is still endemic in many countries, representing an important public health
problem such as the
Mediterranean region. Hydatid
cysts of the liver exert pressure on the surrounding parenchyma, and in
approximately one-fourth of the cases, due to higher pressure in the cyst, the
cysts eventually leak into small bile ducts or perforate into large ones. Intrabiliary rupture
can occur with two different clinical settings which are followed by certain
symptoms. These are occult communication and apparent intrabiliary rupture. We present a case of a hydatid cyst
of the liver which ruptured spontaneously into the common bile duct resulting
in jaundice and cholangitis that treated on emergency.
CASE REPORT
A 13-year-old female patient was admitted with a 5 days history
of painful progressive jaundice. Her liver was not palpable, leucocyte count 10.2x
103/L. Biochemical values were total bilirubin: 7 mg/ dL, conjugated bilurubin:
5.5 mg/dl, aspartate aminotransferase: 61 IU/L, alanine aminotransferase: 106
IU/L, LDH: 324 IU/L, GGT:469IU/L. Abdominal ultrasonography showed a cystic
lesion of 13 x 12 cm in size located in the intraparenchymic hydatid cyst type and
dilated intrahepatic and common bile duct (3.3 cm)
Computed Tomography scan revealed intraparenchymic hydatid
cyst type IV(segments 7,8 and 5th segments) that opened totally into common
bile duct and also showed dilated proximal and narrowed distal choledochal bile
ducts (Figure 1). Patient
under went right subcostal laparotomy was performed. The cyst was seen to
communicate inferiorly with common hepatic duct in the region of ductal
confluence with extension of the hydatid membranes into common hepatic duct and
proximal common bile duct withupstream dilatation of the right and left hepatic
ducts and intra-hepatic biliary radicles with ruptured membranes present, the
right intrahepatic duct was seen communicating with cyst cavity. the cyst was
opened, germinative membrane was extracted, cystectomy and drainage, omentopexy were performed, was cleaned common bile duct through right hepatic duct and then right
hepatic duct repaired the postoperative period was unremarkable and patient was
discharged on day 7.
CONCLUSİON
Frequent
common complication of hydatid hepatic cyst disease is rupture into the biliary
tree. it is usually leads to biliary colic, cholangitis and jaundice. Accurate
diagnosis and emergency
KOLEDOK KANALI TIKANIKLIĞININ NADIR BIR NEDENI; KARACIĞER KIST HIDATIK RÜPTÜRÜ
MH Okur, H Zeytun, B Aydoğdu, E Basuguy, S Otçu
Dicle Üniversitesi Tıp Fakültesi Çocuk Cerrahisi AD
GIRIŞ
Hidatik hastalık hernekadar nadir olsada hala
akdeniz bölgesinde endemik halk sağlığı problemidir. Karaciğer hidatik kisti
olan vakaların dörte birinde yüksek
basınçtan dolayı sonunda küçük veya büyük olan safra yollarına sızar veya
perfore olur. Inrabiliyer rüptür iki farklı klinik oluşturabilir, bunlar gizli
olarak semptom vermez veya aşikardir. Biz bu çalışmada koledoğa spontan rüptüre
olmuş ve sarılık ve kolanjite neden olan acil tedavi ettiğimiz karaciğer kist
hidatiği vakasını sunduk.
VAKA SUNUMU
13 yaşında kız hasta 5 gündür mevcut ağrılı ve ilerleyen sarılık şikayeti
ile başvurdu. Karaciğeri palpabl değildi, leukosit 10.2x 103/L.
Biokimyasal değerleri Total bilirubin: 7 mg/ dL, direkt bilurubin: 5.5 mg/dl,
aspartate aminotransferaz: 61 IU/L, alanine aminotransferaz: 106 IU/L, LDH: 324
IU/L, GGT:469IU/L idi. Abdominal ultrasonografi’de 13x12 cm boyutunda
intraparankimal kistik lezyon ve dilate intrahepatik safra kanalları ve koledok
saptandı (3.3 cm). Bilgisayarlı tomografi ile yapılan görüntülemede; koledoğa
açılan ve koledoğun distalinde daralmaya proksimalinde dilatasyona neden olan
intraparankimal tip IV hydatik kist (segment 5, 7, 8) olduğu saptandı. Hastaya
sağ subkostal laparotomi yapıldı. Kistin inferiordan sağ hepatik kanal vasıtası
ile koledoğa uzanan membranlar mevcuttu, sağ hepatik safra kanalı ile kist
kavitesinin ilişkili olduğu görüldü. Kist açıldı germinatif membran çıkarıldı,
kistektomi ve drenaj yapıldı, sağ hepatik safra kanalından ilerlenip dilate
koledok temizlendi sağ hepatik safra kanalı onarıldı, omentopeksi yapıldı. Ameliyat
sonrası hasta 7. gün sorunsuz olarak taburcu edildi.
SONUÇ
Karaciğer
kist hidatiklerinin sık görülen komplikasyonu biliyer sisteme rüptürüdür.
Genellikle biliyer kolik, kolanjit ve sarılığa neden olur. Eğer karaciğer
hidatik kistinin biliyer sistem ile belirgin ilişkisi varsa doğru tanı ve acil
müdahale zorunludur