CASE REPORT: HEPATIC ECHINOCOCCAL CYST RUPTURE INTO THE BILIARY TREE AND GALLBLADDER

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CASE REPORT: HEPATIC ECHINOCOCCAL CYST RUPTURE INTO

THE BILIARY TREE AND GALLBLADDER

Abidov U.O.

https://orcid.org/0000-0003-4872-0982

Bukhara State Medical

Institute named after Abu Ali ibn Sina

Uzbekistan Bukhara, A.Navoi st. 1

Tel: +998(65) 223-00-50 e-mail:

info@bsmi.uz

Bukhara branch of the Republican

Scientific Center for Emergency

Medical Care Uzbekistan,

Bukhara region, 200100, Bukhara, st

.

Bakhouddin Nakshbandi

159,

tel: +998652252020 E-mail:

bemergency@rambler.ru

Resume. Hepatic echinococcosis complicated by cyst rupture into the bile ducts

and gallbladder is a rare but serious condition requiring immediate medical

attention. This article presents a clinical case of a 36-year-old patient with a hepatic

echinococcal cyst that ruptured into the biliary tree, leading to the development of

mechanical jaundice and cholangitis. The diagnostic methods, including

ultrasound, MRI, and endoscopic retrograde cholangiopancreatography (ERCP),

are described, along with the successful use of endoscopic papillotomy and surgical

treatment (choledochotomy) to remove parasitic elements and drain the bile ducts.

The treatment was supplemented with antiparasitic therapy using albendazole

to prevent recurrence. Early diagnosis and the integration of surgical and

endoscopic methods, combined with medical treatment, significantly improve the

prognosis for patients with this complication.

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Keywords: hepatic echinococcosis, cyst rupture, bile ducts, gallbladder,

mechanical jaundice, cholangitis, choledochotomy, endoscopic papillotomy,

antiparasitic therapy.

Historical reference (description of a hepatic echinococcal cyst that ruptured

into the bile ducts and gallbladder).

The first mention of a hepatic echinococcal cyst rupturing into the bile ducts and

gallbladder appears in medical literature of the late 19th to early 20th century, when

physicians began to more closely study the clinical manifestations of parasitic liver

diseases. Historical descriptions of echinococcosis, including cases of cyst rupture into

the biliary system, began to appear in medical texts during the late 19th century;

however, precise sources for these descriptions were not always documented in the

form of specific scientific publications.

One of the key early references to parasitic liver diseases is found in the work of

the French surgeon Dominique Larrey, who was among the first to study such

conditions. This information is reflected in 19th-century medical treatises such as

"Traité de Chirurgie"

, which describes cases of hepatic echinococcosis and its

complications.

At that time, diagnosis of echinococcosis was limited, and treatment primarily

consisted of surgical interventions, often performed without a clear understanding of

the underlying causes of complications. Only with the development of radiological

techniques and, later, ultrasound diagnostics did it become possible to more accurately

identify and describe such cases. For a more in-depth analysis, it is also advisable to

consult modern literature reviews on the history of echinococcosis and the surgical

treatment of parasitic liver diseases.

Echinococcosis

is a natural-focal zoonotic disease caused by tapeworms of the

genus

Echinococcus

. The most common form is cystic echinococcosis, caused by

Echinococcus granulosus

. It is widespread in endemic regions around the world,

including Central and Middle Asia, Russia, Southern Europe, Turkey, South America,

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Africa, and Australia. The spread of the disease beyond endemic zones is associated

with population migration and increased tourist activity.

The liver is affected in 65–80% of cases of

Echinococcus granulosus

infestation

[1,5,6,8]. Complicated forms of hepatic echinococcosis—such as suppuration, rupture

into the abdominal cavity, or into the bile ducts with the development of obstructive

jaundice—are

observed

in

24.9–54%

of

cases

[2,3,6,8].

Rupture of parasitic elements or daughter cysts into the bile ducts is a rare

complication, occurring in 3.7–7.9% of patients [4,5,8,12].

Intrabiliary rupture of the contents of a hepatic echinococcal cyst is the second

most common complication, following only suppuration of the cyst. It is considered

one of the most severe manifestations of the disease. A major challenge in the treatment

of hepatic echinococcosis complicated by biliary rupture is that patients typically

present at the hospital with various stages of hepatic insufficiency caused by

mechanical obstruction and biliary hypertension. This exacerbates the severity of their

condition, increases the risk of postoperative complications and recurrence, and

prolongs the postoperative rehabilitation period.

An enlarging cyst can compress surrounding structures and lead to hepatic atrophy

and fibrosis [9,11]. Compression and displacement of the bile ducts may often result

in spontaneous rupture.

Timely diagnosis and treatment are essential in cases of intrabiliary perforation or

rupture of a hepatic hydatid cyst, as these can lead to biliary obstruction with up to 50%

mortality [10,11,14].

Following rupture, protoscolices and micro-acephalocysts can survive and

implant into tissues after surgery or cyst rupture [8,10].

Imaging tools such as ultrasound (US), abdominal computed tomography (CT),

magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde

cholangiopancreatography (ERCP) are useful modalities for diagnosing the disease.

Ultrasound and CT are the first-line diagnostic methods and can be used in most

clinical settings [7]. Among more invasive tools, ERCP can aid in definitive diagnosis

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and treatment, particularly sphincterotomy in patients with intrabiliary cyst rupture.

MRCP can help localize the site of biliary obstruction [8,13,15,16].

Currently, the primary method of treatment for intrabiliary rupture of a hepatic

echinococcal cyst is endoscopic clearance of the bile ducts from chitinous membranes,

followed by echinococcectomy.

This article presents the clinical picture of a ruptured hepatic echinococcal cyst

into the bile ducts, including the diagnostic process and treatment of the patient.

We report our own clinical case observation.

A 36-year-old male patient was admitted to the emergency department of the

Bukhara branch of the Republican Scientific Center of Emergency Medical Care with

complaints of right upper quadrant abdominal pain, fatigue, fever, jaundice, vomiting,

yellowing

of

the

skin,

acholic

stools,

and

loss

of

appetite.

According to the patient, symptoms had been present for three days. His general

condition was of moderate severity. He was conscious and alert. The skin and sclerae

were icteric. Blood pressure was within normal limits at 120/80 mmHg, and oxygen

saturation in ambient air was 96%. Body temperature was 38.8°C. On abdominal

palpation, there was tenderness in the right side. Peritoneal irritation signs were

negative.

In addition to laboratory analysis and evaluation of the patient's condition,

abdominal

ultrasound

was

performed

to

support

the

diagnosis.

Ultrasound revealed both intrahepatic and extrahepatic bile duct dilation. The

gallbladder

was

distended

but

with

a

normal

wall

thickness.

Large intact liver cysts were noted in segment IV, surrounded by multilayered

membranes—possibly indicating a ruptured or complicated echinococcal cyst.

Abdominal ultrasound:

A hepatic echinococcal cyst measuring 11 cm in

diameter was detected; no signs of hepatic fibrosis were found. Dilation of intrahepatic

and extrahepatic bile ducts was noted, indicating obstruction. The right lobe of the liver

presented a large solitary cyst with a hyperechoic wall, measuring 11×9 cm, with

multiple internal septations and daughter cysts.

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MRI with cholangiography:

Perforation of the cyst into the bile ducts with

partial obstruction of the common bile duct was confirmed.

Computed tomography (CT):

In the right lobe of the liver, a volumetric lesion

measuring 11×9 cm was observed with smooth edges, clear contours, and a

heterogeneous structure due to multiple rounded cystic inclusions.

Blood tests:

Fibrinogen – 3.9 g/L; General biochemical blood test total protein –

60 g/L; Glucose – 4.7 mmol/L; Urea – 6.0 mmol/L; Total bilirubin – 83 µmol/L;

Hemoglobin – 127×10⁹/L; Erythrocytes – 4.15×10⁹/L; CI – 0.9×10⁹/L; Leukocytes –

5.2×10⁹/L; Eosinophils – 3%; Monocytes – 3%.

The main challenge in treating hepatic echinococcosis complicated by rupture into

the biliary tree is that patients typically present to the hospital at various stages of liver

failure caused by mechanical obstruction and biliary hypertension. This worsens the

severity of their condition, increases the risk of postoperative complications and

recurrence, and prolongs the postoperative rehabilitation period.

The patient underwent endoscopic retrograde cholangiopancreatography (ERCP),

which confirmed the diagnosis. During the procedure, the common bile duct was found

to be dilated to more than 25 mm (Pic. 1).

Pic. 1. A

– ERCP X-ray image of the biliary tract after cyst rupture.

B

– MRI cholangiography.

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One of the key elements of hepatic echinococcectomy is adherence to the

principle of antiparasitic safety (disinfection of the parasite’s germinal elements during

surgery).

In this context, ERCP offers an advantage, as it provides a minimally invasive

option for managing biliary complications of echinococcosis, reducing the need for

more invasive surgical interventions.

The procedure begins with endoscopic papillosphincterotomy, which facilitates

access to the bile ducts. Then, after thorough cleansing of the biliary tract, a catheter is

placed into the bile duct.

Using a special catheter, cannulation of the bile duct is performed, followed by

the injection of contrast material to obtain X-ray images (Fig. 1) (cholangiograms),

which help assess the location of the cysts and the extent of their involvement. With

the use of various instruments such as extraction baskets or balloons, hydatid sand,

membrane fragments, and other cyst components are removed from the bile ducts. The

bile ducts are then thoroughly irrigated to eliminate residual fragments and prevent

infection.

Surgical procedure name: Upper midline laparotomy. Echinococcectomy of

the right liver lobe. Fundus-down cholecystectomy. Drainage of the residual cyst

cavity and the right subhepatic space.

Clinical diagnosis: Tense echinococcal cyst of the right liver lobe.

Complication: Rupture of the echinococcal cyst into the bile ducts. Parasitic obstructive

jaundice.

In the second stage, surgical treatment of the echinococcal cyst was performed via

open method.

An upper midline incision with bilateral extension into the right and left subcostal

regions was made. On the visceral surface of segment IV of the liver, a nodular

formation measuring 11.0×9.0 cm with dense consistency was found, extending to the

left triangular and falciform ligaments; it was adherent to the hepatogastric and

hepatoduodenal ligaments.

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The

common

bile

duct

was

dilated

up

to

25

mm.

Fundus-down cholecystectomy was performed; the cystic duct had a diameter of 10

mm. The lumen of the hepatic duct was opened above the junction of the cystic duct

via a 10 mm longitudinal linear incision. Active discharge of echinococcal cyst

contents and turbid fluid mixed with bile was noted from the common hepatic duct

(Pic. 2).

With full assurance of complete cyst removal, a drain was placed in the subhepatic

space.

Discussion.

Rupture of a hepatic echinococcal cyst into the biliary tree is a rare

but serious complication of echinococcosis. The primary diagnostic method involves

imaging studies such as ultrasound (US), magnetic resonance imaging (MRI), and

endoscopic retrograde cholangiopancreatography (ERCP), which allow for precise

localization of the perforation site and assessment of the extent of biliary tract

involvement.

Pic.2. A–C – Removed gallbladder and cyst contents that ruptured into the bile
ducts and gallbladder. B – Ultrasound showing chitin and echinococcal fluid in the
gallbladder cavity. D – Partial pericystectomy and biliary fistula (indicated by
arrow).

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In recent decades, endoscopic treatment methods such as ERCP have significantly

transformed the approach to managing complicated forms of hepatic echinococcosis.

The advantages of endoscopic intervention include minimal invasiveness, rapid patient

recovery, and the ability to perform both diagnostic and therapeutic procedures

simultaneously.

Surgical treatment of hepatic echinococcosis remains the mainstay of care for

these patients. Communication between parasitic liver cysts and the bile ducts is a fairly

common occurrence, as evidenced by the presence of bile in control drainage following

echinococcectomy. The size and location of the parasitic cyst are risk factors for the

formation of a connection between the cyst cavity and the biliary ducts.

True rupture of daughter cysts or parasitic elements into the hepatic duct

(hepaticocholedochus) is a very rare complication that can lead to bile duct obstruction

with the development of obstructive jaundice and cholangitis. Such situations often

require urgent therapeutic interventions, with a reported mortality rate of 1.8–4.5%.

Conclusion.

In cases of echinococcal cyst rupture into the bile ducts, the clinical

picture is dominated by symptoms of obstructive jaundice, the resolution of which is

essential before definitive surgical intervention can be safely performed. Endoscopic

sanitation and retrograde administration of germicidal agents into the residual cavity

offer promising prospects for reducing disease spread during the second stage of

surgical treatment.

This case demonstrates the successful management of a hepatic echinococcal cyst

rupture into the biliary tree using modern endoscopic technologies.

REFERENCES

1.

Акилов Х.А., Струсский Л.П., Ильхамов Ф.А., Садыков Х.Т. Гнойный

холангит и механическая желтуха как осложнения эхинококкоза печени.

Хирургия Узбекистана. 2001; 3: 26–7.

ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ

https://scientific-jl.org/obr

Выпуск журнала №-69

Часть–3_ Мая –2025

457

2181-3187

2.

Курбонов К.М., Азиззода З.А., Назирбоев К.Р. (2019). Эхинококкоз печени,

осложненный механической паразитарной желтухой. Вестник Национального

медико-хирургического Центра им. Н. И. Пирогова, 14 (1), 30-35.

3.

Лотов А. Н., Чжао А. В., Черная Н. Р. (2010). Эхинококкоз: диагностика и

современные методы лечения. Трансплантология, (2), 18-27.

4.

Махмадов, Ф. И., & Даминова, Н. М. (2010). Результаты хирургического

лечения больных эхинококкозом печени, осложнённым обтурационной

желтухой. Вестник Авиценны, (2), 29-33.

5.

Скипенко О.Г., Полищук Л.О., Чекунов Д.А., Хрусталева М.В., Ким С.Ю.

Прорыв эхинококковой кисты в желчные протоки, осложненный

холедоходуоденальным свищом. Хирургия. Журнал им. Н.И. Пирогова.

2012;(7):80 82.

6.

Хаджибаев А. М., Анваров Х. Э., Хашимов М. А. Диагностика и лечение

эхинококкоза печени, осложненного прорывом в желчные пути // Вестник

экстренной медицины. 2010. №4.

7.

Aghajanzadeh M, Asgary MR, Foumani AA, Alavi SE, Rimaz S, Banihashemi Z, et

al. Surgical management of pleural complications of lung and liver hydatid cysts in 34

patients. Int J Life Sci. 2014; 8:15–19. doi: 10.3126/ijls. v8i4.10893.

8.

Akoglu M, Hilmioglu F, Balay AR, Sahin B, Davidson BR. Endoscopic

sphincterotomy in hepatic hydatid disease open to the biliary tree. Br J Surg. 1990;

77:1073. doi: 10.1002/bjs.1800770940.

9.

Avcu S, Ünal Ö, Arslan H. Intrabiliary rupture of liver hydatid cyst: a case report

and review of the literature. Cases J. 2009; 2:6455. doi: 10.1186/1757-1626-2-6455.

10.

Dolay K, Akbulut S. Role of endoscopic retrograde cholangiopancreatography

in the management of hepatic hydatid disease. World J Gastroenterol. 2014; 20:15253–

15261. doi: 10.3748/wjg. v20.i41.15253.

11.

Erden A, Ormeci N, Fitoz S, Erden I, Tanju S, Genç Y. Intrabiliary rupture of

hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography. AJR Am

J Roentgenol. 2007;189: W84–W89. doi: 10.2214/AJR.07.2068.

ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ

https://scientific-jl.org/obr

Выпуск журнала №-69

Часть–3_ Мая –2025

458

2181-3187

12.

Erden A, Ormeci N, Fitoz S, Erden I, Tanju S, Genç Y. Intrabiliary rupture of

hepatic hydatid cysts: diagnostic accuracy of MR cholangiopancreatography. AJR Am

J Roentgenol. 2007;189: W84–W89. doi: 10.2214/AJR.07.2068.

13.

Sıkar HE, Kaptanoğlu L, Kement M. An unusual appearance of complicated

hydatid cyst: necrotizing pancreatitis. Ulus Travma Acil Cerrahi Derg. 2017; 23:81–

83.

14.

Ufuk F, Duran M. Intrabiliary rupture of hepatic hydatid cyst leading to biliary

obstruction, cholangitis, and septicemia. J Emerg Med. 2018;54: e15–e17. doi:

10.1016/j.jemermed.2017.09.009.

15.

Ufuk F, Duran M. Intrabiliary rupture of hepatic hydatid cyst leading to biliary

obstruction, cholangitis, and septicemia. J Emerg Med. 2018;54: e15–e17. doi:

10.1016/j.jemermed.2017.09.009.

16.

von Sinner WN. Ultrasound, CT and MRI of ruptured and disseminated hydatid

cysts. Eur J Radiol. 1990; 11:31–37. doi: 10.1016/0720-048X (90)90099-W.

17.

Abidov U. O., Obidov I. U. Hepaticofasciolas (Fasciolosis) as a Cause of

Mechanical Jaundice in a Woman (Case Study) //Scholastic: Journal of Natural and

Medical Education. – 2023. – Т. 2. – №. 5. – С. 38-41.

18.

Абидов У. О. и др. ВОЗМОЖНОСТИ ЭНДОСКОПИЧЕСКОГО

СТЕНТИРОВАНИЯ

ПРИ

НЕОПЕРАБЕЛЬНЫХ

ОПУХОЛЯХ

БИЛИОПАНКРЕАТИЧЕСКОЙ ЗОНЫ //Новый день в медицине. – 2020. – №. 4.

– С. 623-625.

19.

Нурбабаев А. У., Абидов У. О. Комплексное лечение больных с синдромом

механической желтухи //Биология и интегративная медицина. – 2020. – №. 6 (46).

– С. 96-102.

20.

Abidov U. O., Khaidarov A. A. MINIMALLY INVASIVE INTERVENTIONS

IN THE TREATMENT OF PATIENTS WITH MECHANICAL JAUNDICE

//Vegueta. Anuario de la Facultad de Geografía e Historia. – 2022. – Т. 22. – С. 6.

ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ

https://scientific-jl.org/obr

Выпуск журнала №-69

Часть–3_ Мая –2025

459

2181-3187

21.

Abidov U. O. Results of Treatment of Patients with Obstructive Jaundice

//Scholastic: Journal of Natural and Medical Education. – 2023. – Т. 2. – №. 5. – С.

370-376.

22.

Абдурахманов, М. М., Обидов, У. У., Рузиев, У. У., & Мурадов, Т. Р.

(2020). Хирургическое лечение синдрома механической желтухи. Журнал

теоретической и клинической медицины, 1, 59-62.

23.

Haydarov, A. A., Abdurakhmanov, M. M., Abidov, U. U., Sadiev, E. S.,

Mirzaev, V. I., & Bakae, M. I. (2021). Endoscopic interventions and ozone therapy in

the complex treatment of patients with mechanical jaundice and cholangitis with

choledocholithiasis. Journal of Natural Remedies, 22(1 (1)), 10-16.

24.

Oktamovich,

A.

U.

(2023).

GALLENSTEINKRANKHEIT

BEI

SCHWANGEREN: DIAGNOSE, KOMPLIKATIONEN UND BEHANDLUNG.

Scientific Impulse, 2(15), 587-595.

25.

Abidov, U. O. (2023). HEPATIKOFASZIOLOSE (FASZIOLOSE) ALS

URSACHE FÜR MECHANISCHEN IKTERUS BEI EINER FRAU (FALLSTUDIE).

INNOVATIVE DEVELOPMENTS AND RESEARCH IN EDUCATION, 2(22), 78-

84.

26.

Abidov U.O., Urokov Sh.T., Sultonzoda N.D. -

RUPTURE OF A HEPATIC

ECHINOCOCCAL CYST INTO THE BILE DUCTS AND GALLBLADDER (A

CASE

REPORT)//New

Day

in

Medicine

10(72)2024

63-68

https://newdayworldmedicine.com/en/new_day_medicine/10-72-2024

27.

Urokov Sh.T., Abidov U.O., Sultonzoda N.D. -

ECHINOCOCCOSIS OF THE

LIVER COMPLICATED BY A BREAKTHROUGH INTO THE BILIARY TRACT

AND THE DEVELOPMENT OF MECHANICAL JAUNDICE: DIAGNOSIS AND

TREATMENT (LITERATURE REVIEW)//New Day in Medicine 10(72)2024 85-95

https://newdayworldmedicine.com/en/new_day_medicine/10-72-2024

28.

Abidov U.O., Urokov Sh.T., Boltayev N.R. -

THERAPEUTIC TACTICS FOR

LONG - TERM MECHANICAL JAUNDICE SYNDROME OF BENIGN

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ETIOLOGY//New

Day

in

Medicine

7(69)2024

62-69

https://newdayworldmedicine.com/en/new_day_medicine/7-69-2024

29.

Boltayev N.R., Urokov Sh.T., Abidov U.O. -

APPLICATION OF

NASOBILIARY

DRAINAGE

IN

TREATMENT

OF

LONG-TERM

OBSTRUCTIONAL JAUNDICE OF BENIGN GENESIS//New Day in Medicine

7(69)2024

47-53

https://newdayworldmedicine.com/en/new_day_medicine/7-69-

2024