Cholecysto-Hydatid Cyst Fistula: A Rare Cause of Cholangitis

Abstract

BACKGROUND Cholecysto-hydatid fistula is a rare complication of liver echinococcosis; suppurative cholangitis due to cholecysto-hydatid fistula is even rarer. A multidisciplinary approach is required by radiology and surgery departments during the preoperative diagnosis and treatment processes of these cases. In this paper, a patient treated with suppurative cholangitis due to cholecysto-hydatid fistula is presented. CASE REPORT A 76-year-old female patient was admitted to emergency services due to cholangitis. Abdominal computerized tomography (CT) examination revealed that the common bile duct was dilated through the right liver in a wide and torsional pattern; the gallbladder cleaved into hepatic flexura and its wall became irregular. There was a cystic appearance 10×13×12 cm in size on the lateral segment of the left liver lobe. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and it showed the communication between the hydatid cyst pouch and the bile duct. The patient was taken to open surgery, which confirmed the imaging findings. The gallbladder and the adjacent cyst were excised, and a T-tube was placed in the choledochus. Postoperative recovery was uneventful. CONCLUSIONS We suggest that cholecysto-hydatid fistula is a severe problem that requires close workup with both the radiology and surgery departments. Preoperative ERCP is beneficial for the visualization of the fistulization between gallbladder and hydatid cyst and for the treatment of suppurative cholangitis.

Figure 1.

Computed tomography images show that there were 2 thick-walled cysts compatible with hydatid cyst (short and long arrows).

Figure 2.

Computed tomography images of the wide and short fistula neck between the gallbladder and the hydatid cyst.

Figure 3.

Endoscopic retrograde cholangiopancreatography illustration of gallbladder fistulation of hydatid cyst in the left lobe of the liver. The cyst was enlarged in nearly all of the left lobe.

Figure 4.

Histopathology image of the hydatid cyst wall consisting of an avascular, eosinophilic chitinous laminated membrane (hematoxylin and eosin stain 100×).