Clinical and paraclinical findings related to the rupture of hydatid cyst into the liver biliary ducts

Background: The rupture of hydatid cyst into the intra-hepatic bile ducts is considered as one of the problematic and important hydatid side effects. Considering the fact that this parasite is endemic in Iran, detection and treatment of hydatid cyst ruptured into the biliary system is crucial for any surgeon. Failure in detecting and predicting this complication can result in irremediable consequences. Methods: This study was retrospective and included 196 patients with liver hydatid cyst who were surgically operated (1994-2005) in hospitals of Isfahan University of Medical Sciences (Kashani Hospital, Isabne Maryam hospital and Al-Zahra Hospital) by the researcher, and among them, 22 patients were excluded because of incomplete records or lack of the conditions required for entering the study, and finally 174 patients were selected for the study. The quantitative and qualitative data were analyzed by t-test and Fisher's exact test respectively, also with Pearson test when necessary, at the statistical significant level of P< 0.05 in SPSS-10 software. Findings: Laboratory findings in patients with liver hydatid rupture was as follows: total bilirubin more than 1 mg/dl (p < 0.05), direct bilirubin more than 0.4 mg/dl (p < 0.05), alanine aminotransferase more than 31.5 u/l (p < 0.05), aspartate aminotransferase more than 29.5 u/l (p < 0.05), jaundice in last two weeks (p < 0.05), cyst size more than 14.5 cm (p < 0.05) and alkaline phosphatase more than 275.5 u/l (p < 0.05). Age, gender, white cell count, and cyst size smaller than 10 cm were insignificant and non helpful in making the diagnosis. Conclusion: In cases that rupture of liver hydatid cyst cannot be detected by ultra-sonography, surgeon must be careful during the operation in exploration for detection of probable rupture of liver hydatid cyst to provide the necessary treatments during the cyst operation and to prevent further operations and side effects. Key words: Complicated hydatid cyst, liver hydatid cyst, hydatid disease, intrabiliary cyst rupture.