Clear cystic fluid in hepatic hydatidosis does not rule out communication between cysts and the biliary system.

Hydatid cysts (HCs) of the liver are a major problem in the areas to which they are endemic. Approximately 15% of hepatic cysts have been shown to communicate with the biliary system. In 2 cases in which patients were undergoing HC surgery, the cystic fluid appeared to be clear, but after the germinative membranes were removed, a connection with the biliary system could be seen. This observation suggests that the decision to inject a scolicidal or sclerosing agent during surgery should be evaluated carefully, as should the use of percutaneous HC treatment. Otherwise, conditions associated with serious morbidity, such as sclerosing cholangitis, may occur.