Vieira V, Alexandrino H, Furtado E, Martinho F
Hospitais da Universidade de Coimbra, Portugal.
J Surg Case Rep. 2012 Apr 1;2012(4):6. doi: 10.1093/jscr/2012.4.6.
Echinococcosis is endemic in Mediterranean regions and is found primarily in the liver. Biliary fistula is a common complication, but major biliary duct involvement is very rare, and occurs in 0.47% of patients with hepatic hydatid disease. Cyst rupture causing secondary peritoneal hydatidosis is a rare but serious complication. We report the case of a 27-year-old man with multiple peritoneal and hepatic hydatid cysts. The patient came to our attention with cholestatic jaundice. Imaging exams showed numerous peritoneal cysts and massive hydatid disease of the liver, which involved the hepatic confluence, with destruction of the right hepatic duct and fistula formation to the left hepatic duct. The patient was treated with pre-operative albendazole therapy and radical surgery, which consisted of resection of all peritoneal cysts and extended right hepatectomy with biliary reconstruction. No recurrence was seen on CT investigations on the 12th month following surgery. Radical surgical approach remains the treatment of choice.
包虫病在地中海地区呈地方性流行，主要发生于肝脏。胆瘘是常见的并发症，但主要胆管受累非常罕见，在肝包虫病患者中的发生率为0.47%。囊肿破裂导致继发性腹膜包虫病是一种罕见但严重的并发症。我们报告一例27岁男性，患有多发性腹膜和肝包虫囊肿。该患者因胆汁淤积性黄疸前来就诊。影像学检查显示大量腹膜囊肿和肝脏广泛的包虫病，累及肝汇合处，右肝管破坏并与左肝管形成瘘管。患者接受了术前阿苯达唑治疗和根治性手术，包括切除所有腹膜囊肿和扩大的右肝切除术及胆管重建。术后第12个月的CT检查未见复发。根治性手术方法仍然是首选的治疗方法。
