P1827 - Recurrent Obstructive Jaundice in a Patient With Hepatic Hydatid Cyst: An Unusual Case Report

Yasmin Gerais, MD¹, Marwan Ahmed, MD², Sammy Hamad, DO¹, Vihan Shah, ³, Omar Alsalman, MD¹, Hasan Sqour, MD², Marwah Alchalabi, MD², Dolly Ewili, MD², Fares Hamad, DO¹, Abdelsalam Sayed, MS⁴, Bachar Hamad, MD⁵, Michelle O'Leary, MD⁵, Kamran Ayub, MD^1
1Ascension Saint Joseph Medical Center, Joliet, IL; ²Ascension Saint Joseph Hospital, Chicago, IL; ³Naperville North, Naperville, IL; ⁴University of Medical Science and Technology, Khartoum, Khartoum, Sudan; ⁵Ascension Saint Joseph Hospital, Joliet, IL

Introduction: Hydatid cyst is a parasitic infection caused by Echinococcus granulosus transmitted to humans through egg ingestion. Symptoms depend on the cyst's location. We present a challenging case of hepatic hydatid cyst with recurrent obstructive Jaundice.

Case Description/Methods: A 43-year-old male Russian immigrant presented with abdominal pain. Physical Exam showed jaundice and RUQ tenderness. Labs showed elevated total bilirubin(7.4 mg/dl), ALP (926 IU/L), AST (123 IU/L), ALT (102 IU/L) and normal lipase. CT Abdomen showed intrahepatic ductal dilation, dilated common bile duct (CBD) to 15 mm, a filling defect in CBD, and 11.7 cm liver cyst. MRCP showed new CBD dilation to 3.1 cm and distal intraluminal soft tissue. ERCP with spyglass, biliary sphincterotomy, and tree sweep revealed debris and pus; plastic stent was placed. Blood cultures grew Klebsiella pneumoniae. Four weeks after being discharged on IV Ceftriaxone for two weeks and oral Albendazole, an elective exploratory laparotomy, ultrasound-guided aspiration of the cyst and saline injection was performed. After three weeks the patient presented with worsening abdominal pain. labs showed elevated liver tests; cholestatic pattern. Repeat ERCP revealed pus, debris and membrane; stent was removed and the CBD was swept.Abdominal pain resolved and liver tests normalized. He was discharged on oral Albendazole.

Discussion: Hepatic hydatid cysts usually present as RUQ pain, nausea and vomiting. Obstructive Jaundice is a rare complication either from intrabiliary cyst rupture, primary biliary involvement or cyst mass effect. Debris drain into the biliary ducts, causing obstructive jaundice and rarely acute cholangitis. In our case hepatic hydatid cyst presented with recurrent obstructive jaundice.Initial ERCP showed debris likely from the hydatid cyst rupture into the intrabiliary system. Jaundice recurred three weeks after surgery. Repeat ERCP showed pus and tissue.Primary hydatid cyst of the biliary tree has been reported in literature but this patient had hepatic hydatid cyst with recurrent jaundice indicating cysto-biliary communication.Yucesory AN reported a similar case of cystic intrabiliary rupture showing germinative membrane as the obstruction’s cause. Only four similar cases were reported in literature. Cyst removal with biliary duct sweeping was the main treatment modality. Our case highlights ECRP’s significance in diagnosing and treating biliary tree hydatid cysts like sealing fistulas, clearing the biliary tree, and addressing its leaks.





Disclosures:


Yasmin Gerais, MD¹, Marwan Ahmed, MD², Sammy Hamad, DO¹, Vihan Shah, ³, Omar Alsalman, MD¹, Hasan Sqour, MD², Marwah Alchalabi, MD², Dolly Ewili, MD², Fares Hamad, DO¹, Abdelsalam Sayed, MS⁴, Bachar Hamad, MD⁵, Michelle O'Leary, MD⁵, Kamran Ayub, MD¹. P1827 - Recurrent Obstructive Jaundice in a Patient With Hepatic Hydatid Cyst: An Unusual Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.