Suppurative Cholangitis Secondary to Intrabiliary Rupture of Hepatic Hydatid Cyst: A Case Report

Background: Suppurative cholangitis is a life-threatening infection resulting from biliary obstruction and ascending bacterial contamination. While choledocholithiasis is the most common etiology, intrabiliary rupture of a hepatic hydatid cyst caused by Echinococcus granulosus represents a rare but serious cause, particularly in endemic regions. Early recognition and prompt biliary decompression are critical to prevent septic complications. Case Presentation: A 38-year-old female with a history of dyslipidemia presented with a two-day history of high-grade fever (39.6°C), chills, right upper quadrant pain, and jaundice. Physical examination revealed scleral icterus, right upper quadrant tenderness, and a positive Murphy sign. Laboratory investigations showed leukocytosis (19,200/µL), elevated C-reactive protein (81.6 mg/L), and a cholestatic liver profile (total bilirubin 4.2 mg/dL, alkaline phosphatase 411 IU/L). Contrast-enhanced computed tomography demonstrated a 7 cm hydatid cyst in the right hepatic lobe with internal septations, dilated intrahepatic bile ducts, and intraductal debris suggestive of cystobiliary communication. Management and Outcome: The patient was diagnosed with suppurative cholangitis secondary to intrabiliary rupture of a hepatic hydatid cyst. She was treated with intravenous fluids, broad-spectrum antibiotics, and albendazole. Urgent endoscopic retrograde cholangiopancreatography (ERCP) revealed purulent bile and obstructing hydatid material; biliary decompression was achieved through sphincterotomy and extraction of debris. Definitive surgical removal of the residual cyst was subsequently performed. The patient recovered uneventfully and remained asymptomatic on follow-up. Conclusion: Intrabiliary rupture of hepatic hydatid cyst is an uncommon but important cause of suppurative cholangitis. Early diagnosis, urgent biliary decompression, and combined endoscopic and surgical management are essential to optimize outcomes. Clinical trial number: Not applicable