Preoperative predictive factors of liver hydatid cyst occult or frank intrabiliary rupture

Abstract

Background: The most frequent complication of liver hydatid cyst is intrabiliary rupture (LHCIBR). This study aimed to investigate preoperative predictive factors of occult and frank LHCIBR.

Methods: We conducted a retrospective study concerning patients operated on consecutively for liver hydatidosis for 2 years. Patients were divided into three groups: who had no intrabiliary rupture, patients who had an occult rupture and patients who had a frank rupture.

Results: We recorded 56 patients with 82 liver hydatid cysts. LHCIBR was occult in 16 cysts and frank in four cysts. Bivariate analysis identified jaundice and cyst size as associated with frank LHCIBR and US cyst type II or III, recurrent cyst, and size of the hydatid cyst as associated with occult LHCIBR. In the multivariate analysis, we retained jaundice, cyst size > 6.5 cm and duration of symptoms > 45 days as significant predictive factors of frank rupture and cyst size > 6.5 cm, number of recurrences ≥ 3, cyst type II or III, leukocytosis > 9.000/mm3 and eosinophilia > 5.5% as significant of occult rupture.

Conclusion: Misdiagnosis LHCIBR can lead to increased morbidity and mortality. They were avoided by predicting cyst rupture, correct timing and type surgery, proper drainage and preoperative intensive care of patients.

Keywords: Liver hydatid cyst; Occult intra-biliary rupture; Frank intra-biliary rupture; complication; predictive factors.