Davidson B, Ezaki T, Habib N
Hepatobiliary and Liver Transplantation Unit, Royal Free Hospital, London, UK.
HPB Surg. 1991;4(4):321-9. doi: 10.1155/1991/58262.
A 36 year old Cypriot woman, resident in the U.K. since the age of three years, presented with pyrexia, jaundice and upper abdominal pain. On ultrasound examination the biliary tree was dilated, contained sludge and a cystic lesion was present in the liver. An endoscopic cholangiogram showed multiple filling defects in the bile duct which were not felt to be removable endoscopically and a nasobiliary drain was therefore inserted. On resolution of the cholangitis with drainage and antibiotics a laparotomy was performed. The right lobe of the liver was largely replaced by a multiloculated cyst and the bile duct contained multiple hydatid daughter cysts. A right hepatectomy was performed with t-tube drainage of the evacuated bile duct. She made an uneventful recovery and has had no problems on subsequent follow up. Histology confirmed an intrabiliary rupture of a hydatid liver cyst. Cholangitis secondary to daughter cysts is a rare but recognised complication of hydatid liver cysts. Management of hydatid liver cysts by formal resection is controversial but may be preferable in this situation.
一名36岁的塞浦路斯女性，自三岁起就居住在英国，出现发热、黄疸和上腹部疼痛。超声检查显示胆管扩张，有胆泥，肝脏存在一个囊性病变。内镜胆管造影显示胆管内有多个充盈缺损，经内镜无法取出，因此插入了鼻胆管引流管。在通过引流和抗生素治疗使胆管炎消退后，进行了剖腹手术。肝脏右叶大部分被一个多房性囊肿取代，胆管内有多个包虫子囊。进行了右肝切除术，并对排空的胆管进行了T管引流。她恢复顺利，后续随访未出现问题。组织学证实为肝包虫囊肿胆管内破裂。子囊肿继发胆管炎是肝包虫囊肿一种罕见但已被认识到的并发症。通过正规切除治疗肝包虫囊肿存在争议，但在这种情况下可能更可取。
