A 35-year-old shepherd from Andhra Pradesh has a 8 cm hepatic hydatid cyst. ERCP before planned surgery demonstrates a cystobiliary communication with mild bile-stained vomitus and intermittent jaundice. Which intervention is contraindicated in this patient?

• A Albendazole therapy before and after surgery
• B PAIR (puncture, aspiration, injection of scolicide, reaspiration) ✓
• C Open cystopericystectomy
• D External drainage of the communicating biliary radicle

Explanation

PAIR is contraindicated when there is a cystobiliary communication, because injection of hypertonic saline scolicide into the biliary tree causes sclerosing cholangitis, and leakage risks chemical injury plus dissemination. Inactive calcified cysts and lung cysts are other exclusions. With demonstrated communication, open surgery with careful closure of the biliary opening, scolicidal soaking of the cavity, and perioperative albendazole is preferred. Albendazole, cystopericystectomy, and controlled drainage all remain valid options here.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.