A Conservative Management of Spontaneously Ruptured Liver Hydatid Cyst

Hydatid disease is a zoonotic disease caused mainly by the cestode (tapeworm) Echinococcus granulosus, also known as hydatidosis. It is endemic mainly in areas where dog/horse breeding and sheep farming are common, such as Australia, New Zealand and the Mediterranean region. A rare, yet serious, complication of hydatid cyst of the liver is rupture, which could be spontaneous due to increased intra-cystic pressure or following a traumatic injury of the abdomen. Rupture into the peritoneal cavity may result in an anaphylactic reaction, usually treated by means of emergency surgical intervention. Herein, we present a case of a 55-year-old male patient, known to have liver hydatid cystic disease 3 years ago, who presented to other hospital with acute abdominal pain, tachycardia and hypotension. A computed tomography (CT) scan of the abdomen revealed ruptured liver hydatid cyst into the peritoneal cavity, with free intra-abdominal fluid and dissemination into the mesentery. The patient was treated successfully by conservative means including nil per os (NPO), intravenous fluids, noradrenaline and anthelminthic treatment by albendazole. Two months later the patient underwent laparoscopic resection of the mesenteric as well as the hepatic cyst. The presentation, diagnosis, course of treatment and follow-up are discussed in this report. Reviewing the current English literature reveals that this is the first case to report a successful initial conservative management of spontaneous intraperitoneal rupture of liver hydatid cyst.