Cystobiliary Fistula in Hepatic Hydatid Cyst in Children
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LETTER TO THE EDITOR
Cystobiliary Fistula in Hepatic Hydatid Cyst in Children Zafer Turkyilmaz1 • Ramazan Karabulut1
•
Cem Kaya1 • Kaan Sonmez1
Received: 7 June 2020 / Accepted: 26 June 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Dear Editor, We read with great interest the article by Akhan et al. about ‘‘Comparison of the Long-Term Results of Puncture, Aspiration, Injection and Re-aspiration (PAIR) and Catheterization Techniques for the Percutaneous Treatment of CE1 and CE3a Liver Hydatid Cysts: A Prospective Randomized Trial. Cardiovasc Intervent Radiol. 2020; https://doi.org/10.1007/s00270-020-02,477-7.’’ They treated 53 CE1 and C3A liver hydatid cyst (LHD) by PAIR and catheterization techniques. They concluded that PAIR should be preferred for treatment of liver CE1 and CE3a cysts due to lower rates of major complications and shorter hospital stay and that catheterization technique should be employed when cystobiliary fistula (CBF) was evident [1]. CBF is the major complication of LHD. Though its incidence in children is unknown, CBF is reported to occur in 13–37% of adults with LHD [2]. Demircan et al. analyzed the records of 191 patients treated for LHD with CBF in 41 patients (21.5%). They suggested that in adults, higher alanine aminotransferase, gamma-glutamyl transferase, total and direct bilirubin levels, as well as cyst diameter [ 8.5 cm were predictive of CBF development [2]. In Akhan et al. series, CBF was detected in four cysts together with three abscesses which were treated with catheterization technique [1]. In one of the rare pediatric LHD series reported in the literature, Demir et al. have stated that the most important factor for the establishment of CBF was the diameter of the cyst being greater than
& Ramazan Karabulut [email protected] 1
Department of Pediatric Surgery, Gazi University Medical Faculty, 06550 Ankara, Turkey
69 mm. In their series, the incidence of CBF was 20.5% in surgery group and 10.3% in PAIR group, in a total of 14.4%, in 97 patients [3]. In our clinic, 61 patients underwent surgical intervention via laparotomy for LHD. The average age of the 39 boys and 22 girls was 11.3 years (range 2–18 years). While 34 of these patients had solitary cysts, the others had two or more cysts. In seven (11.4%) of our cases, the initial aspirate revealed bile stained fluid which of two were treated with percutaneous method previously. In another four (6.5%) cases, the initial aspirate was clear, whereas CBF was found to have established after the removal of the germinative membrane. In all of these 11 cases, the cyst diameter was larger than 10 cm. Preoperative liver function tests were normal in all of these patients. Therefore, we find it imperative to emphasize that an initial aspiration of unstained fluid does not rule out a biliary connection. Although the content is clear in large cysts, we leave an 8–10 F catheter into the cyst at the end of the surgical procedu
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