Cystobiliary Fistula of Liver CE Treatment as a Major Problem
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LETTER TO THE EDITOR
Cystobiliary Fistula of Liver CE Treatment as a Major Problem Okan Akhan1 • Erhan Erdog˘an2 • Turkmen Turan Ciftci1 • Emre Unal1 Ergun Karaag˘aog˘lu3 • Devrim Akinci1
•
Received: 30 July 2020 / Accepted: 18 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Introduction We thank Turkyilmaz et al. for their interest in our work and for sharing their experience on liver cystic echinococcosis (CE) complicated with cysto-biliary fistula (CBF) [1]. We are surprised to read that they performed laparotomy for liver CE in 61 children with an average age of 11.3 years (range 2–18 years) [2]. In our clinic, percutaneous treatment for viable liver CE is almost always the first treatment method of choice as it is associated with lower mortality and complications rates besides shorter length of hospital stay [3, 4]. In selected rare cases such as obvious CBF encountered on imaging and perihepatic or
& Okan Akhan [email protected] Erhan Erdog˘an [email protected] Turkmen Turan Ciftci [email protected] Emre Unal [email protected] Ergun Karaag˘aog˘lu [email protected] Devrim Akinci [email protected] 1
Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
2
Department of Radiology, Eskisehir Yunus Emre State Hospital, 26190 Eskis¸ ehir, Turkey
3
Department of Biostatistics, Hacettepe University, 06100 Ankara, Turkey
intraperitoneal rupture of the cyst, surgery could be considered for treatment [5]. Turkyilmaz et al. [2] found CBF in 11 of their cases (18%). They pointed out that the cyst diameter was larger than 10 cm in all the cases complicated with CBF. They also reported that in four out of these 11 cases the initial cyst aspirate was bile free, however, turned out to be mixed with bile following removal of the germinative membrane. In the remaining 7 cases, the initial cyst aspirate was combined with bile. We agree with the authors that giant liver CE cysts treated by Catheterization technique can be complicated with CBF more than smaller CE cysts. In our series, the catheters were taken out one or a few days later when the daily drainage becomes less than 10 cc in the cysts without fistula formation. However, the catheters of CE cysts with CBF and/or abscess seen in 6 cysts certainly remained longer as pointed out by Turkyilmaz et al. [2]. Cyst diameter was larger than 10 cm in 4 CE cysts out of 6 complicated with CBF and/or abscess in our series. We think it is warranted to have a prospective randomized study to compare the results of PAIR and Catheterization techniques for giant liver CE cysts for the incidence of CBF and other complications. There are two main reasons for CBF development in liver CE. 1.
2.
Primarily: Which means perforation of the hydatid cavity into the biliary tree or peritoneum spontaneously. Secondarily (during or after percutaneous/surgical intervention): Intracavitary pressure of a hydatid cyst is approximat
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