Acute abdomen caused by intraperitoneal rupture of liver hydatid cyst

Jerraya Hichem |

La tunisie chirurgicale - 2019 ; Vol 2019

Resumé

With increasing human migration, spontaneous rupture of hydatid cyst in the peritoneum, although rare, may be encountered in non-endemic countries and should be included in the differential diagnosis of acute abdomen.

We report a case of spontaneous rupture of hepatic hydatid cyst at the peritoneal cavity which presented as an acute abdomen. The abdominal ultrasound was sufficient to make the diagnosis of this rare hydatid complication.

 

Mots Clés

Hydatid disease;spontaneous rupture;acute abdomen;peritonitis

Introduction :

Hydatid disease is an endemic parasitic infection in most sheep farming countries[1]. The natural history of hydatid cyst can be marked by different types of complications dominated by cystic rupture. The rupture can occur for a hydatid cyst of the liver in the bile ducts, thorax and more rarely in the abdominal cavity[2]. Nowadays, with increasing human migration, spontaneous rupture of hydatid cyst in the abdominal cavity, although rare, may be encountered in non-endemic countries and should be included in the differential diagnosis of acute abdomen. 

Article

Case report:

A 52-year-old woman with no previous medical historyexperiencedsudden abdominal pain two days before admission with fever and vomiting. Physical examination found a temperature of 39.6°C andabdominal tenderness. Laboratory tests showed leukocytosis with white blood cells count 15000 /mm3 and C-reactive protein level of 319 mg/L. Abdominal ultrasound (US) showed intra-abdominal fluid and cystic lesion of the liverin segments 5 and 6,measuring approximately 10 cm, whichwas the seat of localized split in the wallgiving the appearance of floating membrane (Figure 1). Urgent laparotomy was performed through a bucket-handle Incision. There was about 3 liters of bilio-purulent fluid in the peritoneal cavity related to the rupture ofhydatid cyst (Figure 2). The abdominal cavity was washed with hypertonic saline (4.5%). The germinative membrane was taken out the cavity of the ruptured cyst (Figure 3). There was a cysto-biliary fistula of 3 mm which was sutured. Unroofing, epiplooplasty and external drainage were performed.The postoperative course was uneventful. Albendazole therapy was prescribed for three months. There was no hydatid recurrence on UStwelve months following surgery.

Discussion:

Intraperitoneal rupture of hydatid cyst is a rare but potentially life- threatening condition. It occurs in 1 to 8% of hydatid cysts[1]. In front of acute abdomen, diagnosis is easily evoked by US and/or computed tomography by showing intraperitoneal fluid with a collapsed cyst.  

In our case, US wassufficient to make the diagnosis by showing the pathognomonic sign of floating membrane within a cystic lesion of the liver. Surgical treatment includes removal of hydatid cyst which usually consists of conservative methods given the context of emergency[1,3] and peritoneal toilet which aims to treat peritonitis and to prevent the risk of secondary peritoneal hydatidosis by using scolicidial agents. We used diluted hypertonic saline (4.5%) to avoidacute hypernatremia and its side effects such as described by Kayaalp[4]. To prevent recurrence following the surgical procedure, albendazole treatment is recommended[2,5] especially as the risk of secondary peritoneal hydatidosis increased after cystic rupture.

 

 

 

 

 

 

Références

  1. Derici H, Tansug T, Reyhan E, Bozdag AD, Nazli O. Acute intraperitoneal rupture of hydatid cysts. World J Surg. 2006;30:1879-83.
  2. Dziri C, Haouet K, Fingerhut A, Zaouche A. Management of cystic echinococcosis complications and dissemination: where is the evidence? World J Surg. 2009; 33:1266-73.
  3. Mouaqit O, Hibatallah A, Oussaden A, Maazaz K, Taleb KA. Acute intraperitoneal rupture of hydatid cysts: a surgical experience with 14 cases. World J Emerg Surg. 2013;8:28.
  4. Kayaalp C, Balkan M, Aydin C et al.. Hypertonic saline in hydatid disease. World J Surg. 2001;25:975-9.
  5. Brunetti E, Kern P, Vuitton DA; Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop. 2010;114:1-16.

 

Author Disclosures:

Authors have no conflicts of interest or financial ties to disclose.

 

 

 

 

 

 

figure 1.jpg

Figure 1:  Abdominal US showed hydatid cyst in segments 5,6 with floating membrane (white arrow)

figure 2.jpg

Figure 2:  Intraoperative findings showing the peritoneal rupture of the hydatid cyst (white arrows) which was located on the right of gallbladder (asterisk)

figure 3.jpg

Figure 3:  Intraoperative image showing the removal of the germinative membrane (asterisk) from the cystic cavity