Usha Rani Dalal, Ashwani Kumar Dalal, Julie Singh, Bharat Kumar
Intrathoracic rupture with resultant pleurobiliary and/or bronchobiliary fistula is a rare but potentially life threatening complication of hepatic hydatid cyst. We report a case of a trans-diaphragmatic rupture of hepatic hydatid cyst resulting in hydatidothorax and biliothorax. CECT abdomen and serology test were consistent with hydatid disease. Patient developed sudden respiratory distress during the hospital stay. Chest examination revealed decreased breath sound on the right side of hemithorax. Chest X-ray and USG showed massive pleural effusion on the right side. Tube thoracostomy was done and 1.5 litre of thick biliopurulent fluid was drained. A repeat CECT chest revealed collapsed right lung with rent in the diaphragm. Decortication was done. In post-operative period bile leak from tube thoracostomy continued, for which ERCP was done which revealed common bile duct obstruction by membranes of hydatid cyst. Evacuation of the membranes, sphincterotomy and stent placement was done by ERCP. Biliary leak subsided completely after 2 days and patient was discharged on 15th postoperative day without any drain. One stage operation through thoracotomy only, is successful in most of the cases as it facilitates simultaneous evacuation of both pleural and hepatic hydatid cysts.
