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Associated Clinical Factors and Proper Management

Mesut Atli, MD; Nuri Aydin Kama, MD; Yunus Nadi Yuksek, MD; Mutlu Doganay, MD; Ugur Gozalan, MD; Murat Kologlu, MD; Gul Daglar, MD

Arch Surg. 2001;136:1249-1255.

Hypothesis  The prediction of an intrabiliary rupture of a hepatic hydatid cyst using associated clinical factors is important for early diagnosis and proper management.

Design  Case series of patients with hepatic hydatid cysts treated between January 1, 1992, and January 1, 2000, in a single institution.

Setting  A tertiary care teaching hospital.

Patients  The clinical findings in 116 patients with a hepatic hydatid cyst were reviewed. Of the 116 patients, 24 (21%) had a cyst-biliary communication: 15 (13%) had an occult rupture, and 9 (8%) had a frank rupture.

Main Outcome Measures  The following variables were analyzed as potential predictors of an intrabiliary rupture: age, sex, type and duration of symptoms, findings on physical examination, leukocyte count, liver function test results, serologic test results, suggestive ultrasonographic findings, ultrasonographic cyst features (type, diameter, number, and localization), and whether the cyst is primary or recurrent.

Results  The independent clinical factors for the presence of an occult rupture were a history of nausea and vomiting (P = .004), alkaline phosphatase level greater than 144 U/L (P = .004), total bilirubin level greater than 0.8 mg/dL (>13.5 µmol/L) (P<.001), and cyst diameter greater than 14.5 cm (P<.001) in multivariate analysis. Multivariate analysis also showed that history of jaundice (P<.001), jaundice found on physical examination (P = .05), cyst diameter greater than 10.5 cm (P = .009), a type IV cyst (P<.001), and suggestive ultrasonographic findings (P<.001) were the independent clinical predictors for the presence of a frank intrabiliary rupture. Patients with cyst-biliary communications had increased morbidity rates (13 [54%] of 24 patients vs 13 [14%] of 92 patients; P<.001) and longer mean postoperative hospital stays (13.7 vs 9.4 days; P = .03) compared with others.

Conclusion  Clinical predictors should be considered for early diagnosis and proper management of intrabiliary ruptures in patients with hepatic hydatid cysts.

From the Fourth Department of Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey.

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