Intrabiliary rupture of hydatid cyst of the liver.

Infestation with Echinococcus granulosus is common in Iraq, where a close relationship exists between dogs, the carnivorous definitive hosts, and sheep, the herbivorous hosts of the parasite. Plants contaminated by eggs of the tapeworm passed in the dog's faeces may be ingested by man, giving rise to hydatid disease. Of 136 cases of hydatid disease affecting various tissues and organs studied and treated during a 3-year period, the liver was involved in 94; intrabiliary rupture occurred in 15. Pain, hectic fever, and obstructive jaundice were invariable in these 15 cases but biliary obstruction became complete in only 7. A palpable mass in the liver was present in 10 cases. Mistaken preoperative diagnoses were made in 4 cases before the true nature of the disease was determined. In the light of our experience four main guidelines to operative management may be formulated: First, the mother cyst, daughter cysts, and debris must be evacuated. Second, the common bile duct must be explored and cleared of daughter cysts, membranous shreds, and hydatid stones and the ampulla of Vater must be dilated; however, sphincterotomy is rarely necessary and should not be performed as a routine. Third, unless there is clear evidence of inflammation or daughter cyst or stone formation in the gallbladder the organ should be preserved, since it may prove useful for future bypass procedures. Finally, the residual cavity of the mother cyst must be drained.