GIT ERCP in IBRH

Dr.Mohamed Al-Shekhani.Dr.Taha Al-Karbuli.Dr.Ali Hussein Ali.

ERCP In the management of intra-biliary rupture of liver hydatid cysts.

[IBRH] IS NOT A RARE COMPLICATION OF OF HYDATID DISEASE OF THE LIVER. SURGERY UNTIL RECENTLY WAS THE ONLY DEFINITIVE TREATMENT .WITH THE INTRODUCTION OF ERCP PREOPERATIVELY OR POSTOPERATIVELY THERE WAS A GREAT REDUCTION IN THE OPERATIVE COMPLICATIONS. THERE ARE REPORTS IN WHICH THE ERCP WAS THE SOLE TREATMENT OF THIS CONDITION . THIS WAS THE MAIN AIM OF THE STUDY OF THESE SERIES OF CASES.

3 types of communications: Occult one when the endocyst or cyst content remain within the pericyst Communicating type where the cystic content spill in to the small biliary canaliculi Frank rupture with the content of the cyst spilling to the biliary tract.

OBJECTIVE: TO EVALUATE ROLE OF ERCP IN THE MANAGEMENT OF CASES OF IBRH.

STUDY OF 16 CASES OF IBRH MANAGED BY ERCP.

SETTING:THE ERCP UNIT OF KURDITAN CENTER FOR GASTROENTEROLOGY & HEPATOLOGY- ASULAIMANEYAH-IRAQI KURDISTAN-IRAQ.MAIN OUTCOME MEASUREMENTS: IMPROVEMENT IN THE SYMPTOMS, OBSTRUCTIVE LIVER FUNCTIONS PATTERN & ULTRASONIC FINDINGS IN THESE PATIENTS FOLLOWING ERCP MANAGEMENT.

METHODS:FROM 2007 -2010 :16 CASES , AGES 10-79 YEARS.PATIENTS WERE FOLLOWED UP CLINICALLY + LAB INVESTIGATIONS , (US) , (CT) OR MRI (WHEN AVAILABLE) , BEFORE AND AFTER ERCP, SOME PATIENTS WERE CONTACTED VIA MOBILE PHONE FOR FOLLOW-UP.

METHODS:ERCP INCLUDED CLEARANCE OF THE RETAINED HYDATID MEMBRANES IN CBD WITH ENDOSCOPIC SPHICTEROTOMY PLUS PLASTIC STENT INSERTION TO FACILITATE DRAINAGE OF REMAINING HYDATID CONTENTS, WHICH WAS REMOVED 3 MONTHS AFTER THE PROCEDURE.

RESULTS: MALES>FEMALES(58% VS 42%) MOST WERE FROM 30-50 YEARS. THE PRESENTATION WAS FEVER, JAUNDICE, ITCHING & RIGHT HYPOCHONDRIAL PAIN IN MOST PATIENTS. THE LIVER FUNCTION TESTS WERE OBSTRUCTIVE PATTERN WITH ELEVATED DIRECT BILIRUBIN & ALKHALINE PHOSPHATES IN MOST PATIENTS. THE TUS REVEALED DILATED COMMON BILE DUCT & SINGLE LIVER CYST IN MOST PATIENTS & 2 OR 3 CYSTS IN OTHERS.

RESULTS:THE ERCP MANAGEMENT LED TO IMPROVEMENT IN CLINICAL, LABORATORY & ULTRASONIC FINDINGS IN 8 PATIENTS & IN THESE 8 PATIENTS ERCP WAS THE ONLY PROCEDURE NEEDED PROVED BY FOLLOW-UP OF THESE PATIENTS FOR 1 YEAR IN 6 PATIENTS & 2 YEARS IN THE OTHER 2 PATIENTS & SURGERY WAS NEEDED IN 7 CASES & ONE PATIENT DIED BECAUSE OF SEPSIS.

CONCLUSIONS: ERCP IS AN IMPORTANT MANAGEMENT STRATEGY FOR PATIENTS WITH IBRH WHICH CAN LEAD TO CLINICAL, LAB & ULTRASONIC IMPROVEMENTS & CAN BE THE ONLY REQUIRED PROCEDURE IN AROUND 50% OF CASES

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