Surgical Management of Calcified Liver Hydatid Cyst Complicated with Thoracobiliary Fistula: A Case Series and Literature Review

Document Type : Case Report


1 General Thoracic Surgeon, Department of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

2 General Surgeon, Department of General & Vascular Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran


Thoracobiliary fistula is a rare complication of hydatid cyst of the liver especially in the calcified form. Surgery is the only medical option. The treatment consists of radical surgical procedures in the majority of the patients. Conservative surgical treatments are performed with high mortality rate. Herein, we will describe two patients of calcified hydatid cysts of the liver whose condition becomes complicated with Thoracobiliary fistula.
The first patient was treated with right thoracotomy and resection of pleural hydatid cysts. Then, were evacuated the ruptured laminated membrane and daughter cysts of infected hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified liver hydatid cyst. The second patient was also treated with right thoracotomy, resection of pulmonary hydatid cysts, evacuation of ruptured bile stained laminated membrane and daughter cysts of hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified cyst cavity.
Our patients underwent conservative surgery which posed a severe risk. Both cases are discussed together with review of the literature.


  1. Pedrosa I, Saiz A, Arrazola I, Ferreiros I, Pedrosa C S. Hydatid disease: Radiologic and Pathologic Features and complications. Radiographics 2000; 20: 795-817.
  2.   Bhat S, Kamble R T, Sundaram P, Joshi J M. Transdiaphragmatic extension of hepatic hydatid cyst. Indian J Chest Allied Sci 2002; 44:191-94.
  3.   Gugenheim J, Ciardullo M, Traynor O, Bismuth H. Bronchobiliary fistula in adults. Ann Surg Jan 1988; 207:90-94.
  4. Peker y, Can MF, Genc O, Gozubuyuk A, Zeybek n, Tufan T. Appropriate approach to bronchobiliary fistula: a cases series with hydatid disease and algorithm of case –based management. Int Surg 2007; 92(4):239-46.
  5.  Prousalidis J, Tzardinoglou E, Kosmidis CH, Katsohis K, Aletras O. Surgical management of calcified hydatid cysts of the liver. Surgery 1999; 11: 253-59.
  6. Kabiri H, Maslout A, Renosman A. Thoracic rupture of Hepatic hydatidosis (123 cases).  Ann Thorac Surg 2001; 72:1883-6.


  1.   Gerazounis M, Athanassiadi K, Metaxas E, Athanassiou M, Kalantzi N. Bronchbiliary fistula due to echinococcosis, Eur J Cardiothorac Surg 2002; 22:306-8.
  2. Tocchi A, Mazzoni G, Miccini M, Drumo A, Cassini D, Colace L, et al. Treatment of hydatid bronchobiliary fistulas: 30 years of experience. Liver Int 2007; 27(2): 209-14.
  3. Aydin U, Yazici P, Onen Z, Ozsoy M, Zeytunlu M, Kilic M, et al. The optimal treatment of hydatid cyst of the liver: radical surgery with a significant reduced risk of recurrence. Turk J Gastrentrol.  2008; 19(1): 33-9.
  4.  Franciosi CM, Romano F, Porta G, Caprotti R, De Fina S, Colombo G, et al. Surgical treatment of hydatid disease of the liver. An experience from outside the endemic area. Chir Ital 2002; 54(5): 667-72.
  5.  Kilani T, Hammami S EL, Horchani H, Ben Milared-Mrad K, Hantous S, Mestiri I, et al. Hydatid disease of the liver with Thoracic Involvement. World J Surg 2001;25:40-45.
  6.  Chong C F, Chong V H, Jalihal A, Mathews L. Bronchobiliary fistula successfully treated surgically. Sigapour Med J 2008;49(8):e208-11
  7.  Greenen JE, Tooli J, Hogan WJ, Dodds WJ, Stewart ET, Mavrelis P, et al.  Endoscopic Sphincterectomy: Follow up evaluation of effects on the sphincter of Oddi. Gastroentrology 1984; 87: 754-8.
  8. Sokouti.M, Montazeri V, Fachrju A. Thoracobiliary Fistula of Calcified Hydatid Cyst of the liver. Iran J Med Sci 2010; 35(1); 65- 68.


  1. Daradkeh S, El-Muhtaseb H, Farah G, Sroujieh AS, Abu-Khalaf M. Predictors of morbidity and mortality in the surgical management of hydatid cyst of the liver. Langenbecks Arch Surg 2007; 392(1): 35-9.