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Inicio Gastroenterología y Hepatología (English Edition) Biliary stenosis secondary to fistulised hydatid cyst that mimics Klatskin tumou...
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Vol. 43. Núm. 8.
Páginas 455-456 (octubre 2020)
Vol. 43. Núm. 8.
Páginas 455-456 (octubre 2020)
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Biliary stenosis secondary to fistulised hydatid cyst that mimics Klatskin tumour
Estenosis biliar secundaria a quiste hidatídico fistulizado que simula tumor de Klatskin
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Cristina Saldaña
Autor para correspondencia
crisaldu@hotmail.com

Corresponding author.
, Federico Bolado, Belén González de la Higuera, Erika Borobio, Maria Angeles Casi
Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
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An 87-year-old woman was admitted for painless obstructive jaundice (bilirubin 5.8 mg/l) with dilation of the intrahepatic bile duct and a suspected Klatskin tumour on a computed tomography (CT) scan (Fig. 1). An adjacent calcified cystic lesion was also reported (Fig. 2).

Figure 1.

Computed tomography image showing bilateral intrahepatic biliary tract dilation and the area of the associated mass effect in the hilum suggestive of malignancy (yellow circle).

(0.05MB).
Figure 2.

Computed tomography image showing 2 round calcified lesions suggestive of hydatid cysts (yellow arrow).

(0.06MB).

Endoscopic retrograde cholangiopancreatography showed a filled cyst in the hilum of the liver fistulised to the bile duct and causing secondary bile duct stenosis and compression (Fig. 3). Given the patient’s age and risk of the cyst re-filling, a decision was made to place an 8-cm uncoated metal biliary stent and confirm contrast emptying. Subsequent clinical and laboratory resolution.

Figure 3.

Endoscopic retrograde cholangiopancreatography image showing a cystic lesion which filled with contrast (yellow area) fistulised to the biliary tract, causing stenosis (white arrow), for which reason an uncoated metal biliary stent with a length of 8 cm and a calibre of 1 cm was placed and drainage was confirmed.

(0.07MB).

Hydatid disease is a zoonotic infectious disease caused by Echinococcus granulosus (with a prevalence of 5%–10% in the Mediterranean region) associated with dogs and livestock1–3 and primarily affecting the liver (45%–75%).1

Although most patients remain asymptomatic, serious complications such as fistulisation have been reported.2

Fistulas (2%–75%) may be due to a connection between the cyst and the duct releasing hydatids into the biliary tract or to a hidden connection between bile duct branches (these usually remain asymptomatic).4

Various factors in fistulisation have been reported such as size (>8.8 cm), cyst type (Gharbi type 3 or 45) and location in the hilum.2,3

Advances in endoscopy enable non-invasive management; placement of a biliary stent, with or without balloon dilation, is the management option of choice.3

References
[1]
B.S. Ahmad, A. Afzal, P. Ashraf, S.A. Abubakar, A. Munir.
Manifestation of hydatid cyst of liver with pancreatitis, cholangitis and jaundice: a case report.
J Pak Med Assoc., 68 (2018), pp. 1097-1099
[2]
N. Akkapulu, H.O. Aytac, I.M. Arer, M. Kus, H. Yabanoglu.
Incidence and risk factors of biliary fistulation from a hepatic hydatid cyst in clinically asymptomatic patients.
Trop Doct., 48 (2018), pp. 20-24
[3]
M. Stojkovic, T. Junghanss, M. Veeser, T.F. Weber, P. Sauer.
Endoscopic treatment of biliary stenosis in patients with alveolar echinococcosis–report of 7 consecutive patients with serial ERC approach.
[4]
J.M. Ramia, J. Figueras, R. De la Plaza, J. García-Parreno.
Cysto-biliary communication in liver hydatidosis.
Langenbecks Arch Surg, 397 (2012), pp. 881-887
[5]
H.A. Gharbi, W. Hassine, M.W. Brauner, K. Dupuch.
Ultrasound examination of the hydatic liver.
Radiology, 139 (1981), pp. 459-463

Please cite this article as: Saldaña C, Bolado F, González de la Higuera B, Borobio E, Casi MA. Estenosis biliar secundaria a quiste hidatídico fistulizado que simula tumor de Klatskin. Gastroenterol Hepatol. 2020;43:455–456.

Copyright © 2020. Elsevier España, S.L.U.. All rights reserved
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