Despite intensive hydatid control measures in New Zealand, hepatopulmonary fistula resulting from infection by the echinococcus granulosus still occurs. Although the patients may quickly become debilitated from coughing bile and pus and associated septic complications, appropriate surgical therapy is usually effective. The exact diagnosis may be obscure, but it is helped by a high index of suspicion. A retrospective study of eight patients seen over a 27-year period is presented, and principles of management are outlined. Where biliary hypertension is not present adequate evacuation of the intrahepatic cysts, obliteration of the cyst space, freeing of the adherent lung, and closure of the pulmonary fistula(e) usually give satisfactory long-term results. Pulmonary lobectomy or segmental resection is seldom required.
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