Broncho-Biliary and Bilio Cutaneous Fistulas: A Severe Complication of Liver's Hydatid Cysts

Fistulas are one of the main complications of hydatid cysts. The case of female patient of 37 years old, came from a rural area, operated first for hepatic hydatid cyst two years ago, then she didn't receive any antiparasitic agents later. Addressed to us for the treatment of biliptysis. The clinical and radiological examination revealed a broncho-biliary fistula associated with a bilio-cutaneous fistula of hydatid origin. In order to restore the biliary tract flow, an Endoscopic Retrograde Cholangiopancreatography (ERCP) with a sphincterotomy and the establishment of a biliary stent has been performed. The surgical treatment consists of a pulmonary and hepato-diaphragmatic disconnection with rather satisfying results. Rabiou S1*, Ouadnouni Y1,2 and Smahi M1,2 1Department of Thoracic Surgery, University Hospital Hassan II-Fez, Morocco 2Faculty of Medicine and Pharmacy, Sidi Mohamed Ben abdellah University-Fez, Morocco Rabiou S, et al. Annals of Clinical Case Reports Surgery Remedy Publications LLC., | http://anncaserep.com/ 2016 | Volume 1 | Article 1165 2 or because of the caustic action of bile on the tracheobronchial tree [1-3]. Exceptionally, an anaphylactic shock can be the inaugural sign [4]. Thus, when facing patients presenting biliptysia, a thoracoabdominal CT scan must complete the assessement. It will allow thoroughly analyze the liver injury, and eventually identify a possible communication between the liver and the lung, and also to evaluate the damaged caused on the lung. The hepatobiliary ultrasound must look for an obstacle or a dilatation on the common bile duct [5]. It also allows us to find the liver hydatid cyst and determine its type [6]. The ERCP, is a major step in the preparation of surgery. It enables us to visualize the fistula and look for an obstruction on the biliary duct. It also permits its desobstruction in order to restore the biliary flow thus avoiding recurrence. In the case of our patient, the fact that we placed a biliary stent endoscopically, permitted the healing of the bilio cutaneous fistula. The surgical treatment consists of a pulmonary and hepato-diaphragmatic disconnection. Low thoracotomy is the approach adopted in this context as it allows the treatment of three levels (Thoracic, abdominal and hepatic). From this we concluded the important role of antiparasitic agents in the prevention of complications of non-operated hydatid cysts, as well as to prevent postoperative recurrence. Although the frequency appears in regression and increased from 16% to 2.5%, it is still a serious complication of hydatid cysts of the liver, due to the multiplicity of lesions that affect the same time the abdominal and thoracic level through the diaphragm. This is in most cases very old hydatid cysts localized in the liver dome. The best knowledge of hydatid disease and the availability of investigative increasingly accurate as abdominal ultrasound appear to have a role in the regression of this frequencies allowing early treatment of hydatid cysts of the liver, avoiding its evolution stage of complications. Figure 1: Percutaneous fisgulography showing liver hydatid cyst fistulized to the skin (Red arrow). Figure 2: Thoraco-abdominal CT Scan objectified a liver hydatid cyst communicating with the lung (yellow arrow).