Cysto-biliary communication (CBC) in hepatic hydatidosis: predictors, management and outcome


  • A. Dinakar Reddy Department of of Surgical Gastroenterology, NRI Medical College and General Hospital Chinnakakani, Guntur District, Andhra Pradesh, India
  • Anuroop Thota Department of General Surgery, NRI Medical College and General Hospital Chinnakakani, Guntur District, Andhra Pradesh, India



Biliary fistula, Cystic echinococcosis, Cysto-biliary communication, Hydatid cyst


Background: Liver hydatidosis is a common health problem in endemic areas. Cystobiliary communication is the most common complication of liver hydatid.

Methods: Cases of liver hydatid operated during the period June 2012 to July 2018 were retrospectively assessed. Patients diagnosed with cystobiliary communication (preoperatively, intraoperatively or postoperatively) were analysed. Demographics, laboratory tests were noted. Computed tomographic (CT) findings including size, location, Gharbi’s type, presence of intrahepatic biliary radical dilatation, CHD and CBD dilatation were noted. Intraoperative findings were noted. Postoperative outcomes and any intervention if done were noted. Results were analysed.

Results: Around 108 patients with liver hydatid underwent surgical intervention. Of which 20 (18.5%) patients were found to have cystobiliary communication. Mean cyst size was 8cms. Location of cyst in segment IV and V commonly. 8 patients were diagnosed preoperatively by elevated bilirubin and alkaline phosphatase and on contrast enhanced computerized tomography. Out of 8, 4 patients underwent preop ERCP and stenting, followed by surgery and the other 4 underwent direct surgery with CBD exploration. 4 were diagnosed intraoperatively and the fistula site sutured. But 2 patients had postop biliary fistula which required postop ERC and stenting. Remaining 8 presented postoperatively with biliary fistula. Of 8 patients, 2 had major and 6 had minor fistulas. Postoperative mortality was 0%.

Conclusions: Cystobiliary communication is more common in males with large cyst size, located in the central segments of liver close to biliary confluence, Gharbi type IV cysts. Timely diagnosis and appropriate management decrease the morbidity and mortality.


Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK. Bile leaks following surgery for hepatic hydatid disease. Ind J Gastroenterol. 2005;2:55-8.

Sakhri J, Ben Ali A. Hydatid cyst of the liver. J Chir (Paris). 2004;6:381-9.

Kayaalp C, Bostanci B, Yol S, Akoglu M. Distribution of hydatid cysts into the liver with reference to cystobiliary communications and cavity-related complications. Am J Surg. 2003;185:175-9.

Secchi MA, Pettinari R, Mercapide C, Bracco R, Castilla C, Cassone E, et al. Surgical management of liver hydatidosis: a multicentre series of 1412 patients. Liver Inter. 2010 Jan;30(1):85-93.

Alper A, Ariogul O, Emre A, Uras A, Ökten A. Choledochoduodenostomy for intrabiliary rupture of hydatid cysts of liver. Brit J Surg. 1987;74(4):243-5.

Atli M, Kama NA, Yuksek YN, Doganay M, Gozalan U, Kologlu M, et al. Intrabiliary rupture of a hepatic hydatid cyst:associated clinical factors and proper management. Arch Surg. 2001;136(11):1249-55.

Unalp HR, Baydar B, Kamer E, Yilmaz Y, Issever H, Tarcan E. Asymptomatic occult cysto-biliary communication without bile into cavity of the liver hydatid cyst: a pitfall in conservative surgery. Int J Surg. 2009;7:387-91.

Paksoy M, Karahasanoglu T, Carkman S, Giray S, Senturk H, Ozcelik F, et al. Rupture of the hydatid disease of the liver into the biliary tracts. Digestive Surg. 1998;15(1):25-9.

Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G. Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery:are there significant preoperative clinical predictors?. Can J Surg 2006;49:177-84.

Kilic M, Yoldas O, Koc M, Keskek M, Karakose N, Ertan T, et al. Can biliary-cyst communication be predicted before surgery for hepatic hydatid disease: does size matter?. Am J Surg. 2008;196(5):732-5.

El Nakeeb A, Salem A, El Sorogy M, Mahdy Y, Ellatif MA, Moneer A, et al. Cystobiliary communication in hepatic hydatid cyst: predictors and outcome. Turk J Gastroenterol. 2017;28:125-30.

Avcu S, Ünal Ö, Arslan H. Intrabiliary rupture of liver hydatid cyst: a case report and review of the literature. Cases J. 2009;2:6455.

Manouras A, Genetzakis M, Antonakis PT, Lagoudianakis E, Pattas M, Papadima A, et al. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture:a case report and review of the literature. Can J Gastroenterol Hepatol. 2007;21(4):249-53.

Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. Radiograph. 2000;20(3):795–817.

Valle-Sanz Yd Y, Lorente-Ramos RM. Sonographic and computed tomographic demonstration of hydatid cysts communicating with the biliary tree. J Clin Ultrasound. 2004;32(3):144–148.

Yildirgan MI, Başoğlu M, Atamanalp SS, Aydinli B, Balik AA, Celebi F, et al. Intrabiliary rupture in liver hydatid cysts: results of 20 years experience. Acta Chirurgica Belgica. 2003;103(6):621-5.

Kumar R, Reddy SN, Thulkar S. Intrabiliary rupture of hydatid cyst: diagnosis with MRI and hepatobiliary isotope study. Br J Radiol. 2002; 75(891):271–274.

Ezer A, Zafer Nursal T, Moray G, Yildirim S, Karakayali F, Noyan T, et al. Surgical treatment of liver hydatid cysts. HPB. 2006;8(1):38-42.

Saylam B, Coşkun F, Demiriz B, Vural V, Çomçalı B, Tez M. A new and simple score for predicting cystobiliary fistula in patients with hepatic hydatid cysts. Surg. 2013;153(5):699-704.

Perdomo R, Alvarez C, Monti J, Ferreira C, Chiesa A, Carbó A, et al. Principles of the surgical approach in human liver cystic echinococcosis. Acta tropica. 1997;64(1-2):109-22.

El Malki HO, El Mejdoubi Y, Souadka A, Mohsine R, Ifrine L, Abouqal R, et al. Predictive model of biliocystic communication in liver hydatid cysts using classification and regression tree analysis. BMC Surg. 2010;10(1):16.

Manouras A, Genetzakis M, Antonakis PT, Lagoudianakis E, Pattas M, Papadima A, Giannopoulos P, Menenakos, et al. Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature. Can J Gastroenterol Hepatol. 2007;21(4):249-53.

Galati G, Sterpetti AV, Caputo M, Adduci M, Lucandri G, Brozzetti S, et al. Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. Am J Surg. 2006;191(2):206-10.

Brunetti E, Junghanss T. Update on cystic hydatid disease. Curr Opin Infect Dis. 2009;22:497-502.

Elbir O, Gundogdu H, Caglikulekci M, Kayaalp C, Atalay F, Savkilioglu M, et al. Surgical treatment of intrabiliary rupture of hydatid cysts of liver: comparison of choledochoduodenostomy with T-tube drainage. Dig Surg. 2001;18(4):289-93.

Manterola C, Vial M, Sanhueza A, Contreras J. Intrabiliary rupture of hepatic echinococcosis, a risk factor for developing postoperative morbidity: a cohort study. World J Surg. 2010; 34: 581-6.

Chautems R, Bühler LH, Gold B, Giostra E, Poletti P, Chilcott M, et al. Surgical management and long-term outcome of complicated liver hydatid cysts caused by Echinococcus granulosus. Surg. 2005;137(3):312-6.

Lewall DB, McCorkell SJ. Rupture of echinococcal cysts: diagnosis, classification, and clinical implications. Am J roentgenol. 1986;146(2):391-4.

Skroubis G, Vagianos C, Polydorou A, Tzoracoleftherakis E, Androulakis J. Significance of bile leaks complicating conservative surgery for liver hydatidosis. World J Surg. 2002;26:704-8.






Original Research Articles