Introduction: Hepatic hydatidosis is still a sanitary scourge in Morocco. This benign condition in itself can evolve into serious complications, the rupture of which in the thorax is an example. The management is cumbersome, requiring a perfect collaboration between many specialists. Material and Method: A retrospective study on the intra-thoracic ruptures of the hydatid cysts of the liver at the CHU Hassan II of Fez over a period of 8 years. Patients were split into 2 groups depending on the nature of the treatment. In the group of patients operated on, the decision was made after a thorough preparation. Preoperative endoscopic sphincterotomy was systematic in the presence of a bilio-bronchial fistula with significant biliptysis. For patients with a contraindication to anesthesia, the treatment was exclusively endoscopic by sphincterotomy. Results: A total of 31 patients were included in the study (18 women and 13 men), of whom 14 had at least one history of hydatid cyst surgery. Clinical signs were dominated by cough and biliptysis. Twenty eight patients had been operated on and the approach was an exclusive right thoracotomy in all cases. Patients were grouped according to the classification of Mestiri: 13 patients were grade IA, 9 grade IIA, 3 grade IVA, 2 grade IIIC, and a single grade IIIA. Thoracotomy was used to treat lesions in the thoracic, diaphragmatic and abdominal stages in all patients. The operative sequences were marked by the occurrence of a persistent hepatic abscess of the residual cavity in 2 patients controlled by antibiotic therapy and the maintenance of drain in hepato-diaphragmatic intervals during 4 weeks. We have deplored 2 postoperative deaths following a septic shock. In 3 patients with a contraindication to general anesthesia, we opted for an exclusive endoscopic treatment which allowed to completely releasing the bile duct with disappearance of the biliptysis. After an average follow-up of 38 months no case of recurrence was noted. Conclusion: Through this study, we wanted to highlight the complexity of the management of liver hydatid cysts ruptured in the thorax whose surgery remains the best treatment at the cost of a heavy morbidity and mortality. This morbidity and mortality can be improved by early and accurate diagnosis, but especially by appropriate pre- and postoperative resuscitation measures.

Author Name: Sani Rabiou

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Keywords: Hydatid cyst; Liver; Thorax; Complication; Thoracotomy; Sphincterotomy

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EISSN: 2474-1647

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