Hydatid cyst of the liver with intrathoracic rupture.

In the last 10 years we have operated on 33 cases of hydatid cyst of the liver with intrathoracic rupture. Twenty-one out of 33 cases ruptured into bronchi, in seven the rupture affected the pleural cavity, and in six simultaneous rupture into the bronchus and pleural cavity occurred. Laboratory tests were not carried out in all cases. The Casoni intradermal test was carried out in 23 cases and was positive in 18. A liver scan was performed in 10 and was positive in all. Conservative operations were carried out in 22 patients. In these the hepatic cavity was evacuated and separately drained. This was followed by suturing the diaphragmatic rupture and also closing the bronchial opening if present. Lung resections were performed in 11 out of 33 cases. In eight lobectomy was carried out and in three segmental resections. Resection was necessary when suppuration and bronchiectatic changes affected the lung. Ruptured cyst into the pleural cavity requires emergency thoracotomy after the anaphylactic shock is over. Removal of the parasite, re-expansion of the lung, and drainage of the pleural and hepatic cavities is necessary. Immediate and late complications occurred in 13 patients. In two postoperative haemorrhage occurred and in two postoperative empyema developed. Recurrent haemoptysis was seen in five, persistent bile fistula in one, and dissemination of hydatid cyst in three. In the remaining 20 cases there was no complication. Operative mortality was nil.