• M Daali, Y Fakir, R Hssaida, A Hajji, and A Hda.
• Service de chirurgie générale, hôpital militaire Avicenne, Marrakech, Maroc.
• Ann Chir. 2001 Apr 1; 126 (3): 242-5.

Study AimThe aim of this retrospective study was to report a series of patients with hydatid cyst opened in the biliary tract, who were operated in Morocco.Patients And MethodFrom 1991 to 1998, among 250 hydatid cysts of the liver operated in the same center, 64 were in communication with the biliary tract (25%). There were 39 men and 25 women. The mean age was 34.2 years (range: 6-60). The revealing symptoms were abdominal pain, jaundice or cholangitis, but the biliary fistula was asymptomatic in more than 50% of the patients. The hydatid cysts were recognized by ultrasonography in all the patients but the biliary fistula was only suspected in 17 patients. The surgical procedure included drainage and sterilization of the cyst, resection of the protruding wall of the cyst (84.4%), unblockage of the main hepatic duct (n = 21) associated with a Kehr drainage, and treatment of the bilio-cystic fistula with suture (n = 23) or double side drainage (n = 24) or cystobiliary disconnection (n = 15).ResultsThere were two postoperative deaths due to septic shock (n = 1) and encephalopathy secondary to a biliary cirrhosis (n = 1). The morbidity rate was 25%. Among complications, there were four subphrenic abscesses, four prolonged biliary leakages and two intestinal obstructions. The main hospital stay was 20 days.ConclusionThe opening of hyatid cysts of the liver into the biliary tract may be silent or revealed by biliary symptoms. The results of this series favour a conservative procedure, including resection of the protruding wall of the cyst and cysto-biliary disconnection, in spite of a high morbidity rate and a long hospital stay.

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