A 62-year-old man had a 2-month history of abdominal distension and right upper quadrant pain. Abdominal CT scan revealed two large intrahepatic cysts and serologic testing forEchinococcus granulosisyielded positive results. Hydatid disease with liver involvement was diagnosed. The patient subsequently underwent laparotomy for deroofing/drainage of the two hydatid cysts and cholecystectomy. A CT scan performed 5 days postoperatively revealed a large perihepatic fluid collection, which proved to be bile-stained on percutaneous drainage. A large volume of bile continued to drain percutaneously. Tc-99m HIDA scintigraphy performed to identify the source of the leak showed the site of bile leakage to lie within the lateral hepatic cystic cavity. Physiologic drainage of bile into the duodenum was also demonstrated, confirming patency of the extrahepatic biliary system.
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