Intrabiliaryrupture of hydatid cyst in a patient with cirrhosis

Acase of 48-year-old male, hepatitis B cirrhosis, hepatic hydatid cyst, jaundice, fever, chills suffered from severe abdominal pain in the right upper quadrant. He was suffered from acute cholangitis and spontaneous bacterial peritonitis, and received intravenous antibiotics but his condition rapidly deteriorated to sepsis and severe hepatic failure. The presence of dilated Common Bile Duct (CBD) containing small cystic lesions suggesting daughter cysts on ultrasonography, which was further verified by Endoscopic Retrograde Cholangiopancreatography (ERCP), along with significant eosinophilia and positive serology test for hydatid cyst, made the diagnosis of intrabiliary rupture of hydatid cyst definite. We performed a delayed endoscopic sphincterotomy which resulted in complete resolution of the clinical picture. The patient was treated with Albendazol and Lamivudin and was referred for surgery