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Among the complications of hydatid liver disease, spontaneous cyst rupture into the biliary tract is unusual, occurring in 3.2-17% of cases. Its endoscopic management has been reported rarely, and corresponding complete photodocumentation is unique. Such a case is described and comprehensively illustrated in a 48-year-old immunocompromised man, presenting with upper abdominal pain, obstructive jaundice, and fever. Impaction of hydatid material into the common bile duct and the papilla of Vater was relieved endoscopically, and the patient was consecutively treated with two courses of mebendazole. This management resulted in complete clinical resolution of hepatic hydatosis after 8 months of follow-up. Complications of overt cyst perforation may be allergic, obstructive, secondary infectious, or metastatic. Ultrasound and computed tomography are complementary tools for diagnosis of hepatic echinococcosis, with endoscopic retrograde cholangiography being the "gold standard" in confirming rupture into the biliary system. Laboratory results are usually non-specific. While surgical excision is the treatment of choice, selected patients may primarily be managed endoscopically, followed by anthelminthic therapy.

译文

在包虫肝病的并发症中,自发性囊肿破裂进入胆道是罕见的,发生在3.2-17% 的病例中。它的内窥镜管理很少有报道,相应的完整照片记录是独一无二的。在一名48岁的免疫功能低下的男子中描述并全面说明了这种情况,该男子表现为上腹痛,阻塞性黄疸发热。内镜下减轻了包虫物质进入胆总管和Vater乳头的影响,并连续接受了两个疗程的甲苯咪唑治疗。经过8个月的随访,这种治疗可使肝囊肿的临床完全消退。显性囊肿穿孔的并发症可能是过敏性,阻塞性,继发性感染或转移性。超声和计算机断层扫描是诊断肝包虫病的补充工具,内窥镜逆行胆管造影是确认胆道系统破裂的 “金标准”。实验室结果通常是非特异性的。虽然手术切除是首选的治疗方法,但选定的患者可能主要是内镜治疗,然后是驱虫疗法。

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