Experimental Study of the Effects of Scolicidal Agents on Liver Bile Ducts

  SUMMARY Scolicidal agents are used by most surgeons during operations for hydatid cysts when these agents are injected into the cys t cavity, they can pass through the communicating passages between the cyst and bile ducts into the large intrahepatic and extrahepatic bile ducts and because of their caustic nature, they have the potential to damage the epithelium of ducts. This epithelial damage may ends into the fibrosis and stricture of intrahepatic and extrahepatic bile ducts, and entity called by some investiga­tors: Caustic sclerosing cholangitis" CSC, (Jacques Belghit, 1986). Sclerosing cholangitis after the surgical removal of an echinococcal cyst of the liver was first described by warren in 1966, in 1981 Khodadadi reported a second case. These investigators suggested that formalin could be involved in the pathogenesis of this condition. In 1982 Mirouze et al, reported 5 other cases of CSC after use of formalin in the treatment of liver echinococcal cyst. They could produce simmillar lesions experimentally by injecting 10% and 20% of formalin, solulion into the gall bladder of two dogs respectively. CSC has also been observed after sterilization of a hydatid cyst with 40% ethanol (Polo Melero, 1981). After these reports much concern has developed about using of scolicidal agents, In the other hand the high recurrence rate after operation of hydatid cysts (about 11 % H, Mottaghian 1978) impress the surgeons to use them. We conducted an experimental animal study to see the effects of commonly used scolicidal agents u pan liver and bile ducts. 0. 5%cc of either 2% formalin, 0.5% certimide, 0.5% silver nitrate and 10% sodium choloride or normal saline, as control, were injected into the common bile ducts of 240 Guinea. Pigs and their livers studied microscopically between 1 day and after 5 months. The results showed that all these agents, except the control, caused fibrosis and stricture of bile ducts. Also formalin caused acute toxic damage of the liver in a large numbr of animals, this effect has mot been reported formerly, the rates of liver fibrosis were 40% for formalin, 18% for cetrimide; 7% for silver sitrate and 4% for hypertonic saline. Liver fibrosis did not occur in the contbol group. Conclusion: All of the scolicidal agents used in this study. caused acute toxic and late irreverssible liver damage. This damage was higher for formalin than others.