Intrabiliary rupture of a hydatid cyst

Hydatid disease is a parasitic zoonotic disease that still remains an important healthcare issue in many countries worldwide. Liver is the most common host of the hydatid cysts. The cyst may rupture into the bile duct, as occurs in 5-25% of cases [1]. This complication may be associated with acute cholangitis and life-threatening sepsis. Endoscopic retrograde cholangiopancreatography (ERCP) is the current diagnostic procedure of choice, enabling visualization of the fistula and drainage of the biliary tree [1]. MRI with magnetic resonance cholangiopancreatography (MRCP) offers noninvasive visualization of the biliary anatomy, with a sensitivity of 75-91.7% and specificity of 82.8-95% [2,3]. A 74-year-old man with longstanding hydatid disease was admitted to our hospital for prolonged fever, rigors and right upper quadrant abdominal pain associated with mild alkaline phosphatase and billirubin elevation. Leukocyte