Blindness following rupture of hepatic hydatid cyst: a case report

A 19 year-old woman admitted to Emergency Department with hypotension, sudden loss of vision and acute abdominal pain. Ultrasound and computed tomography demonstrated an occipital infarct in brain and ruptured intraperitoneal cyst of hydatid liver disease. Urgent laparotomy was performed and it included aspiration of cyst contents, peritoneal washing and drainage. Her vision loss improved by 15 hours postoperatively but generalized seizures were started. Weakness in all extremities was present. Cranial MRI demonstrated ischemia in the areas of middle, posterior and anterior cerebral arteries. She was discharged from the hospital with severe neurological deficits (unable to walk, not able to eat herself). Neurological deficits were improved with physiotherapy after two years. There was no recurrence of hydatid cysts in the follow-up of three years. We assumed that anaphylaxis after intraperitoneal rupture of hydatid liver cyst resulted with hypotension and reduced cerebral perfusion, caused the acute vision loss and other neurological symptoms. This unusual presentation of intraperitoneal rupture should be kept in mind particularly in endemic areas of hydatid disease.