Intrabiliary Rupture of a Hepatic Hydatid Cyst Causing Mechanical Biliary Obstruction: A Case Report of Endoscopic Management With a Self-Expandable Metal Stent.

A 27-year-old Afghan male with no significant medical history presented with a one-month history of epigastric abdominal pain and nausea. Four weeks prior to presentation, he had been diagnosed with a hepatic hydatid cyst in Afghanistan and was prescribed albendazole but was nonadherent to treatment and follow-up. At presentation, he was afebrile and had no clinical jaundice. Contrast-enhanced computed tomography of the abdomen demonstrated an 8.0 cm hydatid cyst in the left hepatic lobe with direct communication with the left hepatic duct and associated dilatation of the intrahepatic biliary ducts and common bile duct, which measured 15 mm. Hyperattenuating material within the distal common bile duct, consistent with impacted hydatid material, resulted in mechanical biliary obstruction, with findings consistent with intrabiliary rupture of the hepatic hydatid cyst. The patient was treated with albendazole and subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP), during which membranous hydatid material was observed emerging from the major papilla. Endoscopic sphincterotomy and balloon sweeping were performed to remove the obstructing material, followed by placement of a self-expandable metal stent for biliary drainage. The patient demonstrated clinical improvement, with resolution of common bile duct dilatation on follow-up ultrasonography. Subsequent hepatic resection of the involved lobes was performed five weeks after ERCP. This case highlights that intrabiliary rupture of a hepatic hydatid cyst may cause significant mechanical biliary obstruction despite the absence of overt clinical jaundice and demonstrates the therapeutic role of ERCP in achieving biliary decompression.