Obstructive jaundice as debut symptom of hepatic hydatid disease. Case series

Introduction: Hepatic hydatid disease (HHD) is a zoonosis, endemic in some Spanish geographical areas. Clinical presentation depends on location, growth rate, size of the cysts. Symptoms typically develop as a result of the compression of adjacent structures or viscera as a result of surrounding inflammation or from the rupture of the cyst into the bile duct, pleural space or peritoneal cavity. Both compression of the biliary tree or the rupture of the cyst can lead to obstructive jaundice (OJ). The primary aim of this study was a cross-sectional analysis of the patients diagnosed of hepatic hydatid disease in our center whose clinical form of presentation was OJ. Method: We prospectively reviewed all patients undergoing hydatid surgery of our center between May 2008 and December 2017. We describe those patients whose clinical form of presentation was OJ. In all of them we performed ERCP preoperatively. Results: Seventy-one patients were operated. OJ was the form of presentation in 9 patients (12.7%) (Table 1). OJ was caused by cysto-biliary communication in 3 patients, one due to recurrence on the hilar plate of HHD treated surgically in 1996, in 4 patients the hydatid cyst produced compression of the main hepatic duct and in one patient no clear etiology was found for the jaundice, no cysto-biliary communication was found on the ERCP neither intra or extrahepatic duct dilatation was found on CT/US. Only in one case, ERCP demonstrated hydatids in bile duct. Preoperative ERCP let us avoiding Kehr tube in 8 of 9 cases. Major morbidity (>IIIa) was high (5/9 cases), greater than in non-jaundiced patients. Conclusion: In endemics areas, HHD should be considered as a possible cause of OJ. In our opinon preoperative ERCP should be performed in all OJ due to HHD. Morbidity rate is higher in HHD jaundiced patients.