Hydatidosis is endemic in the Mediterranean region including morrocco, the Middle and Far East, Australia, New Zealand, and South America—all areas where animal husbandry is common. Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.
Fourteen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 5 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.
Eight of the patients were men and six were women. All of the patients had signs of peritoneal irritation. One patient (7,14%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases, intraperitoneal multiple cysts in 11 cases and heterogeneous cavity or cystic structures in the liver in 12 cases. Computed tomography showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. The ruptured cysts were located in the right lobe of the liver in seven patients, in the left lobe in six patients and in both lobes in one patients. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Partial pericystectomy and drainage was the most frequent surgical procedure. No patients died in the early postoperative period. A total of seven morbidities developed in six patients (35.3%). Median hospital stay was 08 days and median follow-up was 12 months. Intra-abdominal recurrence occurred in one case (7.7%).
Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. The operative procedures, either radical or conservative, should be based on the patient’s condition, the regional characteristics, and the surgeon’s experience. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.
Echinococcosis; Abdomen; Peritonitis; Surgery
AIM: To review the clinical presentation and surgical management of complicated hydatid cysts of the liver and to assess whether conservative surgery is adequate in the management of complicated hydatid cysts of liver.
METHODS: The study was carried out at Sher-i-Kashmir Institute of Medical Science, Srinagar, Kashmir, India. Sixty nine patients with hydatid disease of the liver were surgically managed from April 2004 to October 2005 with a follow up period of three years. It included 27 men and 42 women with a median age of 35 years. An abdominal ultrasound, computed tomography and serology established diagnosis. Patients with jaundice and high suspicion of intrabiliary rupture were subjected to preoperative endoscopic retrograde cholangiography. Cysts with infection, rupture into the biliary tract and peritoneal cavity were categorized as complicated cysts. Eighteen patients (26%) had complicated cysts and formed the basis for this study.
RESULTS: Common complications were infection (14%), intrabiliary rupture (9%) and intraperitoneal rupture (3%). All the patients with infected cysts presented with pain and fever. All the patients with intrabiliary rupture had jaundice, while only four with intrabiliary rupture had pain and only two had fever. Surgical procedures performed in complicated cysts were: infection-omentoplasty in three and external drainage in seven; intrabiliary rupture-omentoplasty in two and internal drainage in four patients. Two patients with intraperitoneal rupture underwent external drainage. There was no mortality. The postoperative morbidity was 50% in complicated cysts and 16% in uncomplicated cysts.
CONCLUSION: Complicated hydatid cyst of the liver can be successfully managed surgically with good long term results.
Liver hydatid disease; Complicated liver hydatid; Drainage; Operative techniques
Hydatid 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.
The 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.
The 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.
Hydatid disease; Spontaneous rupture; Liver
Hepatic hydatid cysts may cause serious complications. Intraperitoneal rupture of hepatic hydatid cyst is rarely seen and the prognosis can be fatal. By experience, we know that it might be difficult to diagnose an unruptured cyst expulsed into the peritoneal cavity. In this report, we present the case of a 54-year-old man with an intraperitoneal cystic mass of 10 cm of diameter which had extruded out from the liver due to a blunt abdominal trauma.
Biliary peritonitis; “fallen” hydatid cyst; trauma
Hydatid liver cysts can rupture into neighboring structures in 15–60% of patients, and most often involves the bile duct, the bronchi, and the peritoneal/pleural cavities. Rarely, chest or abdominal wall involvement occurs that are challenging to manage. This case report and literature review describes the management of patients with chest wall and rib invasion.
Presentation of case
A 74-year-old woman, of Spanish origin, presented with right upper quadrant abdominal pain and tender localized swelling. On computer tomography (CT) assessment, the rupture of a hydatid cyst into the right anterior chest wall was identified. Partial involvement of the 10th and 11th rib were noted. The diagnosis was confirmed by a serological test. Surgical treatment involved a radical en bloc right hepatic resection together with resection of the involved ribs, diaphragm and subcutaneous tissue. Primary diaphragm and wall closures were performed. The postoperative course was uneventful with three weeks of albendazole treatment. CT follow-up at six months demonstrated the absence of recurrence.
Complete resection is the gold standard treatment of patients with hydatid cysts with the aim to remove all parasitic and pericystic tissues.
The present report illustrates that an aggressive surgical en bloc resection is feasible and should be preferred for the treatment of hydatid cysts with rupture into the chest wall, even when the ribs are involved.
Hydatid; Rib; Liver
Spontaneous intraperitoneal rupture with biliary peritonitis in a case of hepatic hydatid cyst is extremely rare but serious complication. It is a surgical emergency with high morbidity and mortality rates. Very few cases have been reported in the literature.
We report an unusual case of a biliary peritonitis due to spontaneous rupture of hepatic hydatid cyst in a male patient of 34 years of age. He presented with acute peritonitis. Contrast enhanced computed tomography 2 days prior to laparotomy showed a dumbbell shaped hydatid cyst of right lobe of the liver with perihepatic fluid collection. At operation 1.5 L bile was found in the peritoneal cavity with rupture of the anterior wall of the cyst and large cystobiliary communication. He was managed with deroofing of the cyst, cholecystectomy, and placement of T tube in the cystobiliary communication and in the extrahepatic bile duct. He developed biliary fistula which was closed over a period of 34 days with conservative therapy. At 6 months follow up patient is well and free of recurrence.
Though rare, ruptured hydatid cyst should be considered in the differential diagnosis of acute abdomen in a patient residing in the endemic zone.
Hydatid cysts, which are endemic to certain areas, typically are found in the liver. Spontaneous intraperitoneal rupture, which can be life threatening, is rare. This article presents a case of spontaneous rupture of a hydatid cyst in a 69-year-old woman who was admitted to the emergency department. The patient had no history of trauma. Abdominal ultrasonography and computed tomography suggested rupture of a hydatid cyst. The patient underwent a partial cystectomy, and the cystic area was washed with hypertonic saline and the peritoneal cavity was washed with isotonic saline and drained. Postoperatively, the patient was treated with albendazole for 3 months. No additional pathology was observed at the 3-, 6-, and 9-month follow-ups. Although rare, a ruptured hydatid cyst should be considered in the differential diagnosis of the acute abdomen in a patient residing in an endemic area.
Liver; Hydatid cyst; Spontaneous rupture
The aim of this study was to review the literature regarding the rupture of hydatid cysts into the abdominal cavity after trauma. We present both a new case of hydatid cyst rupture that occurred after blunt abdominal trauma and a literature review of studies published in the English language about hydatid cyst rupture after trauma; studies were accessed from PubMed, Google Scholar, EBSCO, EMBASE, and MEDLINE databases. We identified 22 articles published between 2000 and 2011 about hydatid cyst rupture after trauma. Of these, 5 articles were excluded because of insufficient data, duplication, or absence of intra-abdominal dissemination. The other 17 studies included 68 patients (38 males and 30 females) aged 8 to 76 years who had a ruptured hydatid cyst detected after trauma. The most common trauma included traffic accidents and falls. Despite optimal surgical and antihelmintic therapy, 7 patients developed recurrence. Complications included biliary fistula in 5 patients, incisional hernia in 2 patients, and gastrocutaneous fistula in 1 patient. Death occurred from intraoperative anaphylactic shock in 1 patient and gastrointestinal bleeding and pulmonary failure in 1 patient. Rupture of a hydatid cyst into the peritoneal cavity is rare and challenging for the surgeon. This condition is included in the differential diagnosis of the acute abdomen in endemic areas, especially in young patients.
Acute abdomen; Diagnosis; Peritonitis; Accident
Intra-peritoneal rupture of hydatid cyst is a rare complication and there is no consensus about its treatment.
The reported case concerns a 25 years old female patient who had been complaining for four months from a moderate pain in the right upper quadrant. No clinical or biological signs of sepsis or allergic reactions were witnessed. Ultrasound and CT examinations showed a multilocular hepatic cyst in addition to multiple unilocular cysts in the abdomen. The suspected diagnosis was hepatic and peritoneal HC and a surgical treatment was scheduled four weeks later. Surgical exploration showed a large ruptured HC on the left lobe of the liver, with daughter cysts in the peritoneal cavity. Left lobectomy of the liver with complete ablation of all daughter cysts and a wide peritoneal lavage were performed. For the three months following the surgery, Albendazole had been given to the patient. No recurrence occurred after four years of follow-up.
Intra-peritoneal rupture of liver HC could be asymptomatic. This case showed that in some cases, occurrence of complications is not systematic. This suggests that urgent surgical treatment is not always mandatory in the absence of alarming signs. Well-conducted medical treatment would reduce the risk of occurrence of secondary peritoneal hydatidosis.
Echinococcosis hepatic; Albendazole; Rupture
Introduction. Hydatid disease (HD) is an infestation that is caused by the larval stage of Echinococcus granulosus. The liver is affected in approximately two-thirds of patients, the lungs in 25%, and other organs in a small proportion. Primary retroperitoneal hydatid cyst is extremely rare. The most common complaint is abdominal pain; however, the clinical features of HD may be generally dependent on the location of the cyst. Case Presentation. A 43-year-old female was admitted with the complaint of abdominal pain. Her physical examination was normal. Computed tomography (CT) revealed a 17 × 11 cm cystic lesion, with a thick and smooth wall that is located among the left liver lobe, diaphragm, spleen, tail of the pancreas, and transverse colon and invading the splenic hilum. Total cystectomy and splenectomy were performed. Pathological examination was reported as cyst hydatid. Discussion. Cysts in the peritoneal cavity are mainly the result of the spontaneous or traumatic rupture of concomitant hepatic cysts or surgical inoculation of a hepatic cyst. Serological tests contribute to diagnosis. In symptomatic and large hydatid peritoneal cysts, surgical resection is the only curative treatment. Total cystectomy is the gold standard. Albendazole or praziquantel is indicated for inoperable and disseminated cases. Percutaneous aspiration, injection, and reaspiration (PAIR) technique is another nonsurgical option.
Hydatid cyst rupture into the abdomen is a serious complication of cystic hydatid disease of the liver (Cystic Echinococcosis) with an incidence of up to 16% in some series and can result in anaphylaxis or anaphylactoid reactions in up to 12.5% of cases. At presentation, 36–40% of hydatid cysts have ruptured or become secondarily infected. Rupture can be microscopic or macroscopic and can be fatal without surgery. Hydatid disease of the liver is primarily caused by the tapeworm Echinococcus granulosus and occurs worldwide, with incidence of up to 200 per 100,000 in endemic areas. Our case describes a 24-year-old Bulgarian woman presenting with epigastric pain and evidence of anaphylaxis. Abdominal CT demonstrated a ruptured hydatid cyst in the left lobe of the liver. A partial left lobe hepatectomy, cholecystectomy, and peritoneal washout was performed with good effect. She was treated for anaphylaxis and received antihelminthic treatment with Albendazole and Praziquantel. She made a good recovery following surgery and medical treatment and was well on follow-up. Intraperitoneal rupture with anaphylaxis is a rare occurrence, and there do not seem to be any reported cases from UK centres prior to this.
AIM: To overview the literature on pancreatic hydatid cyst (PHC) disease, a disease frequently misdiagnosed during preoperative radiologic investigation.
METHODS: PubMed, Medline, Google Scholar, and Google databases were searched to identify articles related to PHC using the following keywords: hydatid cyst, hydatid disease, unusual location of hydatid cyst, hydatid cyst and pancreas, pancreatic hydatid cyst, and pancreatic echinococcosis. The search included letters to the editor, case reports, review articles, original articles, meeting presentations and abstracts that had been published between January 2010 and April 2014 without any restrictions on language, journal, or country. All articles identified and retrieved which contained adequate information on the study population (including patient age and sex) and disease and treatment related data (such as cyst size, cyst location, and clinical management) were included in the study; articles with insufficient demographic and clinical data were excluded. In addition, we evaluated a case of a 48-year-old female patient with PHC who was treated in our clinic.
RESULTS: A total of 58 patients, including our one new case, (age range: 4 to 70 years, mean ± SD: 31.4 ± 15.9 years) were included in the analysis. Twenty-nine of the patients were female, and 29 were male. The information about cyst location was available from studies involving 54 patients and indicated the following distribution of locations: pancreatic head (n = 21), pancreatic tail (n = 18), pancreatic body and tail (n = 8), pancreatic body (n = 5), pancreatic head and body (n = 1), and pancreatic neck (n = 1). Extra-pancreatic locations of hydatid cysts were reported in the studies involving 44 of the patients. Among these, no other focus than pancreas was detected in 32 of the patients (isolated cases) while 12 of the patients had hydatid cysts in extra-pancreatic sites (liver: n = 6, liver + spleen + peritoneum: n = 2, kidney: n = 1, liver + kidney: n = 1, kidney + peritoneum: n = 1 and liver + lung: n = 1). Serological information was available in the studies involving 40 patients, and 21 of those patients were serologically positive and 15 were serologically negative; the remaining 4 patients underwent no serological testing. Information about pancreatic cyst size was available in the studies involving 42 patients; the smallest cyst diameter reported was 26 mm and the largest cyst diameter reported was 180 mm (mean ± SD: 71.3 ± 36.1 mm). Complications were available in the studies of 16 patients and showed the following distribution: cystobiliary fistula (n = 4), cysto-pancreatic fistula (n = 4), pancreatitis (n = 6), and portal hypertension (n = 2). Postoperative follow-up data were available in the studies involving 48 patients and postoperative recurrence data in the studies of 51 patients; no cases of recurrence occurred in any patient for an average follow-up duration of 22.5 ± 23.1 (range: 2-120) mo. Only two cases were reported as having died on fourth (our new case) and fifteenth days respectively.
CONCLUSION: PHC is a parasitic infestation that is rare but can cause serious pancreato-biliary complications. Its preoperative diagnosis is challenging, as its radiologic findings are often mistaken for other cystic lesions of the pancreas.
Echinococcosis; Hydatid cyst; Pancreas; Pancreaticoduodenectomy
Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management. However, the diagnosis and management of complicated hepatic hydatid disease is a special issue. One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts. The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice, cholecystitis, cholangitis, liver abscess, pancreatitis and septicemia. Current treatments for major ruptures can result in high morbidity and mortality rates. Furthermore, ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae, biloma, cavitary infection and obstructive jaundice. In the past, these complications were diagnosed and treated by surgical methods. Currently, complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods. In clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts, or for biliary adverse events after surgery, including persistent biliary fistulae and jaundice. However, controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains. In this article, the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed.
Hydatid cyst; Complications; Intrabiliary rupture; Endoscopic retrograde cholangiopancreatography
Hydatid cysts located in the interatrial septum are especially rare but when they occur, they might cause intracavity rupture. We report on a patient with acute pulmonary embolism caused by an isolated, ruptured hydatid cyst on the right side of the interatrial septum. A 16-year-old-boy with an uneventful history was hospitalized for exercise-induced dyspnea and blood expectorations. Multiple and bilateral opacities were visualized on standard chest x-ray. Signs of right-sided hypertrophy were seen on ECG. Imaging findings led to the diagnosis of pulmonary embolism complicating cardiac hydatid cysts. An operation was performed through median sternotomy to remove the cardiac cyst. The pleural cavity was entered through the fifth intercostal space to withdraw lung hydatid cysts. Operative recovery was uneventful and the patient resumed his normal activities 19 months later. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome.
Echinococcosis; Hydatidosis; Pulmonary embolism; cardiac; hydatid cyst
Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis, but occasional cases of primary peritoneal hydatid disease involving the pelvis have been reported. Occasionally, the cyst does not rupture, but instead enlarges, thus mimicking an ovarian tumour.
We present a 30-years-old woman with an intra-abdominal hydatid cyst that had no communication with the liver. It is therefore probably a primary case of ovarian hydatid cyst, which is very rare. An imprint smear was also taken, which revealed scolex with hooklets.
The incidence of hydatid cyst in the female reproductive system is very low, constituting less than 0.5% of all hydatid cysts. Hence clinicians should consider hydatid cyst among differential diagnosis whenever a cystic pelvic mass is found.
hydatid cyst; echinococcus; ovarian cyst
Hydatid disease is a helminthic anthropozoonosis with worldwide distribution due to the close associations among sheep, dogs, and humans. It can occur almost anywhere in the body with a variety of imaging features, which may change according to the growth stage, associated complications, and affected tissues. A definitive diagnosis requires a combination of imaging, serologic and immunologic studies. Ultrasonography, computed tomography and magnetic resonance imaging are highly accurate in detecting a hepatic hydatid cyst. However, hepatic hydatid cysts in an unusual location and/or of an unusual dimension, with atypical imaging findings, may complicate the differential diagnosis. Surgical treatment remains the best treatment.
We describe an unusual case of a giant hydatid cyst, with exophytic growth from the right lobe of the liver of a 55-year-old Egyptian man. The cyst was strongly adhered to his ipsilateral kidney, which was displaced in a downwards and anterior direction, close to his abdominal wall, simulating a retroperitoneal origin. This atypical growth raised doubts about the most appropriate surgical approach. Magnetic resonance imaging easily clarified the origin of the cyst as our patient’s liver, allowing accurate surgical planning.
Rarely, hydatid cysts can reach an extremely large size without any additional symptoms. Giant cysts need radical therapy because they might lead to perforation and anaphylaxis in some patients. Magnetic resonance imaging is very useful in the study of hydatid disease because of its capacity to allow a large field of view, multiplanar acquisition, and high contrast resolution. In some unusual hepatic presentations, magnetic resonance imaging can be used to determine the correct anatomical relationships.
Hydatidosis is a parasitic infection caused by the encysted larvae of Echinococcus granulosus, commonly called as hydatid cyst. Almost all organs can be involved, but most commonly it affects liver (55%–70%) followed by the lungs (18%–35%). The surgery and anesthetic management become very challenging if these cysts are in or near the vicinity of vital organs, such as heart. Pulmonary hydatid cysts may rupture into the bronchial tree or pleural cavity and produce cough, chest pain, or hemoptysis and there are chances of injury to heart if the cyst is in close proximity to it. We are describing the successful management of such a case of pulmonary and hepatic hydatid cyst in a young female patient.
Double lumen tube; E. granulosus; hydatid cyst; one lung ventilation; thoracoscopy
Objective: Clinical approach and therapeutic methods are important in cases with complicated hydatid cysts of the lung. This study was designed to retrospectively investigate cases with hydatid cysts, thereby discussing diagnostic methods, treatment modalities, and rates of morbidity and mortality in line with the literature. Methods: 176 cases with perforated hydatid cysts, who presented to our clinic and underwent surgery between 2003 and 2011, were included in the study. There were 71 (40.34%) females and 105 males (59.66%) with a mean age of 27.80±14.07. The most common symptom was dyspnea (44.31%) and the most common radiological finding was the water lily sign (21.02%). 88.06% of the cases were surgically treated by Cystotomy+closure of bronchial opening+ capitonnage, 3.97% by wedge resection, 4.54% by segmentectomy and 3.40% by lobectomy. Results: The cysts exhibited multiple localization in 24 cases (13.63%), bilateral localization in 14 cases (7.95%), with the most common localization (43.75%) being the right lower lobe. While the hydatid cyst rupture occurred due to delivery in three (1.70%), trauma in 11 (6.25%), and iatrogenic causes in seven (3.97%) cases, it occurred spontaneously in the rest of the cases (88.08%). Fourteen of the cases with spontaneously occurring rupture (7.95%) were detected to have received anthelmintic treatment for hydatid cyst during the preoperative period (albendazole). The rate of morbidity was 27.27% and the rate of mortality was 1.13% in our study. Two cases recurred during a one-year follow-up (1.13%). Conclusion: Hydatid cyst rupture should be considered in the differential diagnosis of cases with pleural effusion, empyema, pneumothorax and pneumonia occurring in endemic regions. Symptoms occurring during and after perforation lead to errors in differential diagnosis. Performing the surgery without delay favorably affects postoperative morbidity and mortality. While parenchyma-preserving surgery is preferential, there is a need for resection in perforated hydatid cysts.
Hydatid cyst; rupture; management
Hydatid disease of the liver is still a major cause of
morbidity in Greece. Beside the common complications
of rupture and suppuration, calcification of the
hepatic cysts represent a not well studied, less frequent
and sometimes difficult surgical problem. In
the present study 75 cases with calcified symptomatic
liver echinococcosis were operated on in the
1st Propedeutic Surgical Clinic between 1964 to
1996. Twenty-eight patients were male and 47 female
with ages from 23 to 78 years. The diagnosis was
based mainly on the clinical picture and radiological
studies. In 5 cases the operative method was
cystopericystectomy. We performed evacuation of
the cystic cavity and partial pericystectomy and
primary closure of the residual cavity in 6 cases,
omentoplasty or filling of the residual cavity with a
piece of muscle of the diaphragm in 4 cases and
external drainage by closed tube, in 60 cases. In 12 of
those with drainage, after a period of time, a second
operation with easy, removal of most of the calcareous
wall plaques was performed. The mortality rate
Our results could be considered satisfactory. In
the calcified parasitic cysts of the liver the proposed
technique is cystopericystectomy. An alternative
procedure is pericystectomy and drainage with
a “planned” reoperation with a bloodless, due
to intervening inflammation, chiseling of the
The hydatid disease most often involves the liver and the lungs. The disease can involve any part of the body except the hair, teeth and nails. Primary extrahepatico-pulmonary hydatid cysts are rare and only a few sporadic cases have been reported.
Materials and Methods:
Two hundred and forty-four patients with hydatid cysts managed surgically from January 2005 to December 2009 were evaluated retrospectively. Fourteen (5.7%) patients had isolated involvement of the atypical sites, while six (2.4%) also had a primary involvement of liver.
The cysts were present in gall bladder (0.4%), peritoneum (1.6%), spleen (1.6%), ovary (0.4%), subcutaneous (0.8%), seminal vesicle (0.4%), spinal (0.4%), pancreas (0.4%), kidney (0.4%), mediastinal (0.4%), muscle (0.4%), and brain (0.8%).
Discussion and Conclusions:
Involvement of sites other than liver and lungs by hydatid disease is rare. Symptoms are related to size, location or possible complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.
Atypical locations; hydatid; echinococcosis
Echinococcosis is endemic in Mediterranean regions and is found primarily in the liver. Biliary fistula is a common complication, but major biliary duct involvement is very rare, and occurs in 0.47% of patients with hepatic hydatid disease. Cyst rupture causing secondary peritoneal hydatidosis is a rare but serious complication. We report the case of a 27-year-old man with multiple peritoneal and hepatic hydatid cysts. The patient came to our attention with cholestatic jaundice. Imaging exams showed numerous peritoneal cysts and massive hydatid disease of the liver, which involved the hepatic confluence, with destruction of the right hepatic duct and fistula formation to the left hepatic duct. The patient was treated with pre-operative albendazole therapy and radical surgery, which consisted of resection of all peritoneal cysts and extended right hepatectomy with biliary reconstruction. No recurrence was seen on CT investigations on the 12th month following surgery. Radical surgical approach remains the treatment of choice.
Hydatid disease is caused by the larval stage of the genus Echinococcus. Live hydatid cysts can rupture into physiologic channels, free body cavities or adjacent organs. Although hydatid disease can develop anywhere in the human body, the liver is the most frequently involved organ, followed by the lungs. Cysts of the spleen are unusual. There are only five case reports of spontaneous cutaneous fistulization of liver hydatid cysts in the literature. But there isn’t any report about cutaneous fistula caused by splenic hydatid cyst. We report a first case of spontaneous cutaneous fistula of infected splenic hydatid cyst.
A 43-year-old man was admitted to our Emergency Service with abdominal pain and fluid drainage from the abdominal wall. He has been suffering from a reddish swelling on the abdominal wall skin for four months. After a white membrane had been protruded out from his abdominal wall, he was admitted to our Emergency Service. On physical examination, a white membrane was seen to protrude out from the 2 cm x 1 cm skin defect on the left superolateral site of the umblicus. Large, complex, cystic and solid mass of 9.5 cm-diameter was located in the spleen on ultrasonographic examination. At operation, partial cystectomy and drainage was performed. After the operation, he was given a dosage of 10 mg/kg per day of albendazole, divided into three doses. He was discharged on the postoperative 10th d. It should be kept in mind that splenic hydatid cysts can cause such a rare complication.
Hydatid cyst; Cutaneous fistula; Spleen
Cystic echinococcosis, which is caused by the larval stages of Echinococcus granulosus, results from the presence of one or more massive cysts or hydatids, and can involve any organ, including the liver, lungs, heart, brain, kidneys, and long bones. Muscle hydatidosis is usually secondary in nature, resulting from spread of larval tissue from a primary site after spontaneous or trauma-induced cyst rupture or after release of viable parasite material during invasive treatment procedures. Primary muscle hydatidosis is extremely uncommon, because implantation at this site would require passage through the filters of the liver and lung. Intramuscular hydatid cyst can cause a variety of diagnostic problems, especially in the absence of typical radiologic findings. We present an unusual case of a primary hydatid cyst found in the popliteal fossa of the right knee of a 52-year-old woman, presenting as an enlarging soft-tissue tumor for 6 months associated with pain. The mass initially was diagnosed to be Backer′s cyst by ultrasonography, but later it was confirmed postoperatively through histopathological studies to be due to hydatid disease. In regions where hydatidosis is endemic, hydatid cyst should be included in the differential diagnosis of any unusual muscular mass.
Echinococcus; muscle hydatidosis; popliteal fossa; primary hydatid cyst; scolicidal agent
Hydatid disease, caused by Echinococcus granulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur following rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. Rarely cyst may develop de-novo in the peritoneal cavity without involvement of any other intra-abdominal organs. We present a unique case of 56-year-old woman with a primary intraabdominal hydatid cyst in the right iliac fossa masquerading as appendicular lump.
Rupture into the abdominal cavity is a rare but serious complication of hydatid disease that necessitates emergency surgical intervention. We present herein a case with mild abdominal symptoms due to hydatid cyst rupture into the peritoneum after trauma. A 24-year-old man was admitted to the emergency room with mild abdominal pain. His symptoms had started after a fall four days earlier. Ultrasonography and computed tomography showed cystic lesions in the liver and peritoneum with intraabdominal free fluid. He was treated surgically with partial cystectomy and falciformoplasty. Postoperative albendazole therapy was given for two months. There was not recurrence four months postoperatively at control computed tomography.
Hydatid disease; Liver; Trauma; Rupture