N Agarwal, P Dewan
hydatid cyst, liver, portal hypertension
N Agarwal, P Dewan. Portal Hypertension as a Rare Complication of Hydatid Cyst: Diagnosis and Management. The Internet Journal of Gastroenterology. 2009 Volume 9 Number 1.
Hydatid cyst of the liver is a significant health problem in endemic areas.
Place of study/Source
Department of Surgery, Lady Hardinge Medical College and Associated Hospitals, Delhi, India, and Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Hydatid cyst of the liver is a significant health problem in endemic areas. In India, the disease has a high prevalence, particularly in the farming community.
There are 3 reports where the authors have identified a pre-hepatic mechanism causing PHT in LH. [4,5,11] El Fortia
From these cases, it may be ascertained that pre-hepatic PHT is usually caused by a unilocular hydatid cyst. CT scan would be useful for delineating the obstruction. Treatment in most cases would be surgical removal of the obstructing cyst, or, porto-systemic shunt surgery.
Cirrhosis of the liver with portal fibrosis can occur in advanced cases of LH. This mechanism has been reported in 10 cases by 3 authors. [7,10,13] In most of these patients, the offending organism was
There are twelve instances of post-hepatic PHT, or the Budd-Chiari syndrome due to LH described in literature. [2,6,8,9,13] Of these, nine patients had EA. In alveolar disease, the post-hepatic mechanism often co-exists with cirrhosis, and the treatment and prognosis for such patients is similar to those described by Bresson-Hadni  (
We feel that due to the rarity of the condition, no recommendation can be made, and the treatment needs to be individualized. Operative resection seems to be an attractive option more for unilocular disease. The patients with LH and chronic Budd-Chiari syndrome would be very difficult to identify in the clinical setting. Ascites may be the only symptom, and liver functions may be normal. A high index of suspicion is required, along with careful interpretation of the subtle CT findings. Direct measurement of portal pressure by invasive techniques is not practical in the clinical setting.
When the ascites is acute in onset, the first suspicion must be of cyst rupture, and urgent steps must be taken to provide definitive treatment and prevent anaphylaxis. A single case of acute Budd-Chiari syndrome due to unilocular cyst has been reported. 
Review of previous experiences of this rare manifestation of LH leads us to the following conclusions:
PHT in LH is rare, and can occur by all three mechanisms. The exact mechanism in a particular case depends on the cyst type (unilocular or multilocular), and cyst location. Identification of the mechanism helps in deciding therapy.
A patient of LH with ascites or gastrointestinal bleed must be suspected to have PHT, but only after satisfactorily ruling out cyst rupture as the cause of ascites.
CT scan is useful in diagnosis, and specific CT signs have been identified. Doppler ultrasound may also be helpful for follow-up of treated patients.
EA is more commonly responsible for PHT, by causing either liver cirrhosis or the Budd-Chiari syndrome. A few cases of
For localized disease, operative resection is a feasible option, especially with