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.
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Karawi et al. (1987) studied this question.