Endoscopic ultrasound in hepatobiliary hydatid disease.

complication of hepatic hydatidosis seen in 1–25% of cases [1]. We present a case of hepatic hydatidosis with biliary rupture identified by endoscopic ultrasound (EUS). A 45-year-old man presented with a 15day history of fever, right hypochondrial pain, and jaundice. Examination revealed icterus and right hypochondrial tenderness. Investigations revealed polymorphonuclear leukocytosis and a cholestatic pattern of liver function tests. Ultrasound of the abdomen revealed an ill-defined, lobulated, 10.9-cm hyperechoic lesion in the right lobe of the liver, with dilatation of the biliary system up to the lower end of the common bile duct (CBD). The possible diagnoses were choledocholithiasis with cholangiolitic abscess or hepatic hydatidosis. EUS (Pentax 3630 UR and 3870 UTK, Pentax Corp., Tokyo, Japan) revealed a dilated CBD with floating membranes (●" Fig. 1 and ●" Videos 1, 2). On endoscopic retrograde cholangiography (ERC), linear filling defects were noted within the dilated CBD (●" Fig. 2). Biliary sphincterotomy and balloon sweeping of the CBD resulted in expulsion of the bilestained hydatid membranes (●" Fig. 3). An occlusion cholangiogram showed contrast entering a cavity in the liver (●" Fig. 4). A 7-Fr, double pigtail plastic stent was placed close to the cavity in the CBD to facilitate drainage. The patient’s condition Endoscopic ultrasound in hepatobiliary hydatid disease