Resolution of hydatid liver cyst by spontaneous rupture into the biliary tract

Among the complications of hydatid liver disease, spontaneous cyst rupture into the biliary tract is unusual, occurring in 3.2–17% of cases. Its endoscopic management has been reported rarely, and corresponding complete photodocumentation is unique. Such a case is described and comprehensively illustrated in a 48-year-old immunocompromised man, presenting with supper abdominal pain, obstructive jaundice, and fever. Impaction of hydated material into the common bile duct and the papilla of Vater was relieved endoscopically, and the patient was consecutively treated with two courses of mebendazole. This management resulted incomplete clinical resolution of hepatic hydatosis after 8 months of follow-up, Complications of overt cyst perforation may be allergic, obstructive, secondary infectious, or metastatic. Ultrasound and computed tomography are completely tools for diagnosis of hepatic echninococcosis, with endoscopic retrograde cholagiography being the “gold standard” in confirming rupture into the biliary system. Laboratory results are usually non-specific. While surgical excision is the treatment of choice, selected patients may primarily be managed endoscopically, followed by anthelminthic theraphy.