Spontaneous intraperitoneal rupture of hepatic hydatid cyst: a rare cause of ascites

Abstract

BackgroundHydatid disease is endemic in certain areas of the world and it is located mostly in the liver. Intraperitoneal rupture is rare. Rupture may result from trauma or may occur spontaneously from increased pressure of the cystic fluid. Ruptured hydatid cyst is a rare cause of ascites, but should be considered in the differential diagnosis, especially in endemic areas. The diagnosis of ruptured hydatid cyst should be prompt because it requires emergency intervention.Case presentationThe present case refers to a 62 year old Tunisian male admitted in our institution for diffuse abdominal distension. Physical examination was unremarkable except for the presence of ascites. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity associated with many intraperitoneal cysts with a scalloping on the liver. It showed also a heterogeneous cystic lesion of the segment II of the liver. Abdominal computed tomography (CT) revealed in addition a fat infiltration and a thickening of the peritoneum. Thus intraperitoneal hydatid cyst rupture was suspected and emergency laparotomy was performed. A yellow serous fluid , containing many daughter vesicles disseminated through the peritoneal cavity was noted. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface. Thus, intraperitoneal rupture of hepatic hydatid cyst was diagnosed.ConclusionThe rupture of hydatid cyst into the peritoneal cavity is rare but presents a challenge for the radiologist and the surgeon. This condition is included in the differential diagnosis of ascites in endemic areas.

Traumatic rupture of liver hydatid cysts into the peritoneal cavity of an 11-year-old boy: a case report from Iran

“…Here, the hydatid fl uid and sands, brood capsules, and protoscoleces are released into the spaces of the peritoneum. A long-term outcome of direct rupture into the peritoneal spaces is the implantation of protoscoleces, which leads to a metastatic form of the disease 11 . Direct ruptures of HCs into the peritoneal spaces take two main clinical forms with different manifestations: small fi ssures and large ruptures.…”

“…The former is very common and is caused by an ordinary trauma that is unrecognized, while the latter is rare and is caused by sudden and severe blunt trauma 10 . HC ruptures cause severe clinical presentations that are accompanied by abdominal pain, urticarial rash, anaphylaxis, and sometimes sudden death 5,11 . In this situation, as there may be allergic reactions or anaphylactic shock, the rupture requires emergency medical care 10 .…”

“…The preoperative diagnosis of ruptured HCs must be confirmed immediately as emergency intervention is essential 11 . This diagnosis requires a complex workup, such as ultrasonography and a CT scan.…”

“…The CT scan is the main diagnostic tool for this condition as it has high sensitivity (100%). It is used to determine the exact site of HC ruptures and HC features such as the presence of daughter cysts in the abdominal cavity 10,11 . A histopathological examination is the fi nal confi rmatory diagnosis tool for the identifi cation of the causative agents of the HCs.…”

Anaphylaxie bei rupturierter Echinokokkuszyste

“…In diesen sog. Hydatiden bilden sich Tochterblasen, in denen sich die Parasiten ungeschlechtlich (vegetativ) vermehren [3,4].…”