Surgical management of a hepatic hydatid cyst fistulized into the duodenum: A case report

Abstract

Introduction and importance Hydatid cyst of liver is a disease usually seen in endemic regions. Fistulization into duodenum is one of the most exceptional complications of the hydatid cyst commonly discovered during surgery. This paper aims to present and discuss a rare case of cyst ruptured into the duodenum. This case report has been reported in line with the SCARE criteria 2020. Case presentation A 44-year-old female patient, previously diagnosed with hydatid cyst of liver with deferred care due to the period of COVID 19 containment, presented with the complaints of abdominal pain and fever. Abdominal CT scan showed up a 2 cm multiseptal hydatid cyst in the segment III of the liver with an exovesiculation of 20 cm, communicating with the first duodenum. The patient underwent antrectomy involving the first duodenum and removing the cystoduodenal fistula with a Roux-en-Y anastomosis. She was discharged with full recovery on the postoperative 5th day. Clinical discussion Clinical features of hydatid cyst fistulized into the duodenum are non-specific. There are two pathognomonic symptoms, hydatidemesis and hydatidenteria.Typically, cysto-duodenal fistula is intra-operatively discovered. The CT scan is the most used morphological examination. The presence of air in the cyst should alert for the gastrointestinal fistula formation. Surgical strategies to perform should be tailored to every patient and to intra operative findings. The post-operative morbidity and mortality are underestimated in the literature. Conclusion The fistulization of Hydatid cyst into the duodenum should be evoked in front of any acute abdominal pain whether or not associated with hydatidemesis or hydatidenteria.

Kist hidatiğin nadir prezantasyonu: hepatik arter psödoanevrizma kanaması ve senkron duodenal fistül

“…The most common complications of liver hydatid cyst are infection and perforation into the biliary tree. The perforation into the gastrointestinal tract is very rare 2 . In this case report, we aim to present a patient with liver hydatid cyst which is perforated into the duodenum and caused an upper gastrointestinal bleeding due to the ruptured hepatic artery pdeudoaneurysm.…”