Ann Ital Chir. 2020 May 25;9:S2239253X20029503.
The most serious complications of liver hydatid cyst disease are fistulization into biliary tract, compression of adjacent vascular structures, anaphylactic reaction, and perforation. Fistulization between liver hydatid cyst and gallbladder tract is an extremely rare complication with only a few cases reported so far. Herein, we aimed to report a 43-year-old man who was diagnosed as having a cholecysto-hydatid cyst fistula. The patient presented to emergency department with signs and symptoms of cholangitis. His biochemical tests revealed elevated AST, ALT, GGT, and bilirubin levels. The radiological examinations (CT, MRCP) revealed a lesion consistent with hydatid cyst (Hydatid cyst ELISA IgG +) with an approximate size of 90*65 mm, which was posterolateral to the gallbladder and fistulized into the latter. In order to relieve pressure within the biliary tract, ERCP with sphincterotomy was performed. He was taken to the operating room a few days later. After draping sponges soaked with 3% NaCl onto the surgical field, near-total pericystectomy + omentopexy + cholecystectomy + common bile duct exploration + T-tube drainage were performed. Bile duct opening to the posterior wall of the cyst was sutured with a prolene suture. Albendazole treatment was started on first postoperative day. After taking a cholangiogram on 21st postoperative day, the T-tube was removed without any complication. In conclusion, cholecysto-hydatid cyst fistula is an extremely rare complication of hydatid cyst disease even in endemic regions. The gold standard for the diagnosis is the combined use of characteristics of clinical presentation, biochemical parameters, and radiological studies. Treatment plan is designed on the basis of the relationship of a fistulized cyst with other bile ducts. KEY WORD: Cholecysto-Hydatid Cyst Fistula, Gallbladder, Hydatid Cyst, Liver.
肝包虫囊肿病最严重的并发症是胆道瘘管形成、邻近血管结构受压、过敏反应和穿孔。肝包虫囊肿与胆囊道之间的瘘管形成是一种极其罕见的并发症，迄今为止仅报道了少数几例。在此，我们旨在报告一例 43 岁男性患者，被诊断为胆-包虫囊肿瘘管。患者因胆管炎的症状和体征就诊于急诊。他的生化检查显示 AST、ALT、GGT 和胆红素水平升高。影像学检查（CT、MRCP）显示符合包虫囊肿（包虫囊肿 ELISA IgG+）的病变，大小约为 90*65mm，位于胆囊的后外侧，并与后者瘘管相通。为了减轻胆道内的压力，进行了 ERCP 加括约肌切开术。几天后他被送往手术室。在手术部位铺上浸有 3%NaCl 的海绵后，行近全囊壁切除术+大网膜固定术+胆囊切除术+胆总管探查术+T 管引流术。用丙纶缝线缝合胆管通向囊肿后壁的开口。术后第一天开始服用阿苯达唑治疗。术后第 21 天行胆管造影后，无并发症拔除 T 管。总之，即使在流行地区，胆-包虫囊肿瘘管也是包虫囊肿病的一种极其罕见的并发症。诊断的金标准是结合临床表现、生化参数和影像学研究的特点。治疗方案是根据瘘管囊肿与其他胆管的关系来设计的。关键词：胆-包虫囊肿瘘管、胆囊、包虫囊肿、肝脏。
