A 30-year-old shepherd from a sheep-rearing region has a 7 cm hepatic hydatid cyst classified as WHO stage CE3a showing the water lily sign. Preoperative ERCP excludes communication between the cyst and the biliary tree. Which option is NOT an indication for the PAIR procedure in his case?
- A CE1 and CE3a cyst stages
- B Patients unfit for open surgery
- C Cysts communicating with the biliary tree ✓
- D Relapse after previous surgery
Correct answer: C. Cysts communicating with the biliary tree
Explanation
PAIR (puncture, aspiration, injection of scolicidal agent, reaspiration) is recommended for WHO CE1 and CE3a cysts, patients unfit for surgery, and relapsed cases. Communication with the biliary tree is a recognised contraindication because injection of a scolicidal agent such as hypertonic saline into the biliary system causes sclerosing cholangitis, and such cysts require surgical drainage of the biliary communication instead. This makes option C the correct choice for this negative-framing item.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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