Syndrome de Budd-Chiari : complication rare du kyste hydatique du foie : à propos de trois cas Budd-Chiari syndrome: a rare complication of hepatic echinococcosis: report of three cases

Introduction: Hydatid disease is a parasitic infestation due to the development of Echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be affected by hydatidosis, and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd–Chiari syndrome have rarely been reported. Case reports: We report three rare cases of hydatid cyst complicated by Budd–Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients, and its diameter was 12.5, 21 and 12.5 cm, respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the other two cases. The Budd–Chiari syndrome was chronic in one patient and asymptomatic in other cases. The diagnosis was established by abdominal ultrasound (US) in two cases, confirmed by Doppler US and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the third case. The Budd–Chiari syndrome was due to the compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in another case. Laparotomy was performed in all patients. The surgical procedure comprised the resection of the protruding hepatic tissue after puncture aspiration of the cyst in all the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage, and by the development of ascites in one case. N. Maamouri (*) · F. Ben Hariz · N. Belkahla · S. Guellouz · S. Chouaib · N. Ben Mami Service de gastroenterologie B, hopital La Rabta, 1007 Tunis Jebbari, Tunisie e-mail : nadiamaamouri1939@yahoo.fr K. Nouira Service de radiologie, hopital La Rabta, Tunisie Z. Ben Safta Service de chirurgie generale A, hopital La Rabta, Tunisie J. Afr. Hepatol. Gastroenterol. (2011) 5:193-197 DOI 10.1007/s12157-011-0278-y