CardioVascular and Interventional Radiology

, Volume 34, Supplement 2, pp 266–270 | Cite as

Refractory Cystobiliary Fistula Secondary to Percutaneous Treatment of Hydatid Cyst: Treatment with N-Butyl 2-Cyanoacrylate Embolization

  • Murat CanyigitEmail author
  • Mehmet Gumus
  • Nurdan Cay
  • Bekir Erol
  • Mustafa Karaoglanoglu
  • Okan Akhan
Case Report


A 27-year-old female with a type 2 hydatid cystic lesion in the liver according to the Gharbi classification (CE 3A according to the WHO classification) was referred for percutaneous treatment after albendazole treatment for 1 year. A catheterization technique was performed but hypertonic saline and alcohol were not given into the cavity due to cystobiliary leakage. During the 4-month follow-up period, sequential cavitography revealed biliary fistula, and bile-stained drainage had not been ceased despite the sphincterotomy, nasobiliary drainage catheter, and plastic stent. Since the patient refused to surgery, we embolized the biliary fistula using N-butyl 2-cyanoacrylate for the first time in the literature. At the 3-month follow-up, the patient’s course was uneventful and ultrasound, multidetector-row CT, and MRI examinations revealed no collection in or adjacent to the cavity.


Hydatid cyst Fistula Percutaneous treatment Glue Embolization 


  1. 1.
    Czermark BV, Akhan O, Hiemetzberger R et al (2008) Echinococcosis of the liver. Abdom Imaging 33:133–143CrossRefGoogle Scholar
  2. 2.
    Turgut AT, Altin L, Topcu S et al (2007) Unusual imaging characteristics of complicated hydatid disease. Eur J Radiol 63:84–93CrossRefPubMedGoogle Scholar
  3. 3.
    Akhan O, Canyigit M, Kaya D et al (2009) Long-term follow-up of the percutaneous treatment of hydatid cyst in the adrenal gland: a case report and review of the literature. Cardiovasc Interv Radiol. doi: 10.1007/s00270-009-9672-x
  4. 4.
    Lewis JW, Koss N, Kerstein MD (1975) A review of echinococcal disease. Ann Surg 181:390–396CrossRefPubMedGoogle Scholar
  5. 5.
    Ustunsoz B, Akhan O, Kamiloglu MA et al (1999) Percutaneous treatment of hydatid cysts of the liver: long-term results. AJR Am J Roentgenol 172:91–96PubMedGoogle Scholar
  6. 6.
    Akhan O, Ozmen MN (1999) Percutaneous treatment of liver hydatid cysts. Eur J Radiol 32:76–85CrossRefPubMedGoogle Scholar
  7. 7.
    Ezer A, Nursal TZ, Moray G et al (2006) Surgical treatment of liver hydatid cysts. HPB 8:38–42CrossRefPubMedGoogle Scholar
  8. 8.
    Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G (2006) Occult cystobiliary communication presenting as postoperative biliary leakage after hydatid liver surgery: are there significant preoperative clinical predictors? Can J Surg 49:177–184PubMedGoogle Scholar
  9. 9.
    Prousalidis J, Kosmidis C, Kapoutzis K et al (2009) Intrabiliary rupture of hydatid cysts of the liver. Am J Surg 197:193–198CrossRefPubMedGoogle Scholar
  10. 10.
    Avcu S, Unal O, Arslan H (2009) Intrabiliary rupture of liver hydatid cyst: a case report and review of the literature. Cases J 10(2):6455CrossRefGoogle Scholar
  11. 11.
    Akhan O, Dincer A, Gokoz A et al (1993) Percutaneous treatment of abdominal hydatid cysts with hypertonic saline and alcohol. An experimental study in sheep. Invest Radiol 28:121–127CrossRefPubMedGoogle Scholar
  12. 12.
    Akhan O, Ozmen MN, Dinçer A, Sayek I, Göçmen A (1996) Liver hydatid disease: long-term results of percutaneous treatment. Radiology 198:259–264PubMedGoogle Scholar
  13. 13.
    Ben Amor N, Gargouri M, Gharbi HA et al (1986) Traitment du kyste hydatique du foie du mouton par ponction sous echographie. La Tunusie Med 64:325–331Google Scholar
  14. 14.
    Schipper HG, Lameris JS, van Delden OM, Rauws EA, Kager PA (2002) Percutaneous evacuation (PEVAC) of multivesicular echinococcal cysts with or without cystobiliary fistulas which contain non-drainable material: first results of a modified PAIR method. Gut 50:718–723CrossRefPubMedGoogle Scholar
  15. 15.
    Akhan O, Gumus B, Akinci D, Karcaaltincaba M, Ozmen M (2007) Diagnosis and percutaneous treatment of soft-tissue hydatid cysts. Cardiovasc Interv Radiol 30:419–425CrossRefGoogle Scholar
  16. 16.
    Etlik O, Arslan H, Bay A et al (2004) Abdominal hydatid disease: long-term results of percutaneous treatment. Acta Radiol 45:383–389CrossRefPubMedGoogle Scholar
  17. 17.
    Smego RA Jr, Bhatti S, Khaliq AA et al (2003) Percutaneous aspiration-injection-reaspiration drainage plus albendazole or mebendazole for hepatic cystic echinococcosis: a meta analysis. Clin Infect Dis 37:1073–1083CrossRefPubMedGoogle Scholar
  18. 18.
    Manouras A, Genetzakis M, Antonakis PT et al (2007) Endoscopic management of a relapsing hepatic hydatid cyst with intrabiliary rupture: a case report and review of the literature. Can J Gastroenterol 21:249–253PubMedGoogle Scholar
  19. 19.
    Men S, Hekimoglu B, Yucesoy C, Arda IS, Baran I (1999) Percutaneous treatment of hepatic hydatid cysts: an alternative to surgery. AJR Am J Roentgenol 172:83–89PubMedGoogle Scholar
  20. 20.
    Saremi F, McNamara TO (1995) Hydatid cyst of the liver: long-term results of percutaneous treatment using a cutting instrument. AJR Am J Roentgenol 165:1163–1167PubMedGoogle Scholar
  21. 21.
    Dumas R, Le Gall P, Hastier P et al (1999) The role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease. Endoscopy 31:242–247CrossRefPubMedGoogle Scholar
  22. 22.
    Cil BE, Turkbey B, Canyigit M et al (2007) An unusual complication of carotid stenting: spontaneous rectus sheath hematoma and its endovascular management. Diagn Interv Radiol 13:46–48PubMedGoogle Scholar
  23. 23.
    Cil BE, Turkbey B, Canyigit M et al (2006) Transformation of a ruptured giant pulmonary artery aneurysm into an air cavity after transcatheter embolization in a Behcet’s patient. Cardiovasc Interv Radiol 29:151–154CrossRefGoogle Scholar
  24. 24.
    Baysal T, Soylu A (2009) Percutaneous treatment of simple renal cysts with n-butyl cyanoacrylate and iodized oil. Diagn Interv Radiol 15:148–152PubMedGoogle Scholar
  25. 25.
    Yang FS, Cheng SM, Yu YY et al (2006) Use of cyanoacrylate glue for sclerosis of a recurrent symptomatic hepatic cyst. J Vasc Interv Radiol 17:401–402CrossRefPubMedGoogle Scholar
  26. 26.
    Cekirge S, Akhan O, Ozmen M, Saatçi I, Besim A (1997) Malignant biliary obstruction complicated by ascites: closure of the transhepatic tract with cyanoacrylate glue after placement of endoprosthesis. Cardiovasc Interv Radiol 20:228–231CrossRefGoogle Scholar
  27. 27.
    Gorich J, Rilinger N, Sokiranski R et al (1996) Percutaneous transhepatic embolization of bile duct fistulas. J Vasc Interv Radiol 7:435–438CrossRefPubMedGoogle Scholar
  28. 28.
    Vu DN, Strub WM, Nguyen PM (2006) Biliary duct ablation with N-butyl Cyanoacrylate. J Vasc Interv Radiol 17:63–69CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Murat Canyigit
    • 1
    Email author
  • Mehmet Gumus
    • 1
  • Nurdan Cay
    • 1
  • Bekir Erol
    • 1
  • Mustafa Karaoglanoglu
    • 1
  • Okan Akhan
    • 2
  1. 1.Department of RadiologyAnkara Ataturk Education and Research HospitalAnkaraTurkey
  2. 2.Department of RadiologyHacettepe University HospitalsAnkaraTurkey

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