BILIO-PLEURO-BRONCHIAL FISTULA COMPLICATING A HYDATID CYST OF THE LIVER: ABOUT A RARE CASE

Introduction: The hydatid cyst is a parasitic disease still endemic in Morocco as well as in several countries, it affects with predilection the liver, biliopleurobronchial fistula is a rare (2.5 to 16%) and threatening complication of hepatic hydatidosis with a poor prognosis.

Observation: We report the case of a 40-year-old female from a rural area, suffering for 2 months from pain in the right hypochondrium, with notion of biliptysia and who was presented to the emergency room for respiratory distress, clinical examination finds a right fluid effusion syndrome.The posteroanterior chest roentgenogram showed a homogeneous opacity occupying the totality of right thoracic field. The thoracic CT showed a right pleural effusion of high abundance associated with a hydatid cyst of the liver, the pleural puncture brought back a frankly purulent liquid, the patient thus benefited from a thoracic drainage in emergency with resulting from an immediately purulent then saffron-like liquid whose chemical study objectified the presence of bilirubin, because of the presence of bile in pleural fluid and the notion of biliptysia a bronchial fibroscopy was made and showed the presence of bile in the bronchial suction fluid. The diagnosis of a biliopleurobronchial fistula was retained, and the patient benefited an endoscopic sphincterotomy with a good evolution then a pleural decortication and closing of the fistula.

Conclusion: The incidence of bilio-pleurobronchial fistula complicating a hydatid cyst of the liver is rare which can be life-threatening, we report a new observation and we insist through this work on a rapid initial management of the hydatid cyst of the liver, in order to avoid progression to serious complications such as biliopleurobronchial fistula as well as rapid and adequate management of this medical, endoscopic and surgical fistula.