Acute intraperitoneal rupture of hydatid cysts of the liver

Abstract

Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures’ details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.There were 9 men and 6 women. Patients’ age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome.

Acute abdomen due to rupture of a hydatid cyst of the liver: a rare complication – a case report

“…Direct rupture occurs when both the endocyst and the pericyst tear release cyst contents directly into the peritoneal or pleural cavities or occasionally into other structures 15 . Ultrasound has a sensitivity of 85% and allows the detection of the cyst as well as to suspect cyst rupture by showing a floating membrane with intraperitoneal fluid 16 . Computed tomography (CT) has a sensitivity of 100% in demonstrating cyst rupture.…”

“…CT is mostly preferred because it allows imaging of the entire abdomen and pelvis. In direct rupture, CT shows various findings like a detached membrane, cyst wall discontinuity, change in the architecture of the cyst or presence of daughter cysts, and fluid in the peritoneal cavity 8 , 16 .…”

“…Patients with uncomplicated hydatid cysts may require follow-up with ultrasonography and indirect hemagglutination test starting 6 months after surgery and subsequently repeated every 1–2 years. Patient with ruptured hydatid cyst requires scrupulous follow-up after surgery within a short interval 7 , 16 , 21 . Recurrence and secondary hydatidosis must be looked up.…”

Spontaneous Intraperitoneal Rupture of Hydatid Cysts of the Liver with Encapsulating Peritonitis: A Case Report

“…The second type is a "communicating rupture," which occurs when the cyst ruptures into a bile or vascular duct. The third type is a "direct or free rupture," which happens when the cyst ruptures into the peritoneal cavity [6].…”

“…"While intraperitoneal cystic rupture is a rare complication of hydatid disease, it still occurs in a significant number of cases, ranging from 1% to 16% of reported cases. Intraperitoneal cyst rupture can occur spontaneously and may be caused by an increase in pressure within the cyst" [6,7].…”