Non-surgical endoscopic trans-papillary treatment of ruptured echinococcus liver cyst obstructing the biliary tree.

Previous reports showed that surgery is the only method of treating liver hydatid cysts that have ruptured into the biliary system. We report a case of obstructive jaundice due to spontaneous rupture of a liver hydatid cyst into the biliary system, which was treated non-surgically by endoscopic papillotomy and extraction of daughter cysts from the biliary system, insertion of a nasobiliary tube for drainage and injection of scolicidal hypertonic saline, into the biliary system. Clear resolution of the obstruction, disappearance of daughter cysts and a decrease in the size of the hepatic cyst was shown by ERCP, ultrasound and CT scan. We believe that this new method is safe, effective and has a lower incidence of mortality, morbidity and recurrence than surgery, which it should replace whenever possible.