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Acute intraperitoneal rupture of hydatid cysts of the liver: Case series
Atef Mejri1,2, Khaoula Arfaoui1,2, Ahmed Omry1,2
1Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia.
Insights
Ruptured hepatic hydatid cysts are life-threatening emergencies requiring immediate intervention. Prompt surgical management, including cyst unroofing and peritoneal lavage, leads to favorable outcomes with no recurrence in this study.
Area of Science:
- Medicine
- Parasitology
- Surgery
Background:
- Hydatid cyst, caused by Echinococcus granulosus, is typically benign.
- Hepatic hydatid cyst rupture into the abdominal cavity is a critical, life-threatening event.
- Urgent, multidisciplinary management is essential for ruptured hepatic hydatid cysts.
Purpose of the Study:
- To describe the clinical and paraclinical features of hepatic hydatid cyst rupture into the peritoneal cavity.
- To detail the appropriate treatment strategies for this condition.
- To report on patient outcomes following management.
Main Methods:
- Retrospective review of 15 cases of ruptured hepatic hydatid cysts from January 2012 to December 2019.
- Inclusion criteria: patients hospitalized for liver hydatid cyst complicated by acute rupture into the abdominal cavity.
- All patients underwent emergency laparotomy with conservative unroofing, peritoneal lavage, external drainage, and intensive care.
Main Results:
- 15 cases identified out of 625 liver hydatid cysts.
- Most common symptom was acute abdominal pain; only one patient experienced anaphylactic shock.
- Imaging revealed discontinuous cyst walls and intraperitoneal fluid; surgery confirmed clear or purulent effusion. All patients recovered without recurrence.
Conclusions:
- Rupture of hepatic hydatid cysts must be considered in cases of acute abdominal pain, especially with anaphylaxis signs in endemic areas.
- Early emergency room management is crucial for a good outcome.
- Surgical intervention involving unroofing, lavage, and drainage is effective.
Abstract:
Hydatid cyst is a parasitic infection caused mainly by Echinococcus granulosus, which is generally considered benign. However, the hepatic hydatid cyst rupture in the abdominal cavity is a life-threatening incident that requires urgent and multidisciplinary management (emergency physicians, radiologists, anesthetists, and surgeons). This study describes clinical and paraclinical liver hydatid cyst rupture in the peritoneal cavity and details the appropriate treatment.A retrospective review of clinical records of patients hospitalized in Jendouba Hospital for liver hydatid cyst was performed over 8 years, from January 1, 2012 to December 31, 2019. Fifteen cases of liver hydatid cyst complicated with acute rupture into the abdominal cavity were collected out of 625 hydatid liver cysts. All patients underwent emergency laparotomy allowing conservative unroofing procedure associated with peritoneal lavage and external drainage combined with necessary intensive care measures. Clinical features, therapeutic procedures' details as well as postoperative outcomes are reported. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 20.There were 9 men and 6 women. Patients' age ranged from 14 to 59 years, with an average of 38 years. Two patients were admitted with abdominal trauma. Acute abdominal pain was the most common complaint. Only 1 patient had an anaphylactic shock. Abdominal ultrasonography and computed tomography scan showed discontinuous cyst wall associated to intraperitoneal fluid in all cases. Intraoperatively, the intraperitoneal effusion was clear in 13 cases and purulent in 2. All patients underwent unroofing procedures associated with intra-operative peritoneal lavage and external drainage. The mean hospital stay was 6.11 days, and the mean follow-up was 19 months. No case of recurrence was reported among the patients.In endemic areas, rupture of a hepatic hydatid cyst in the abdominal cavity should be considered in every case of acute abdominal pain, especially if associated with anaphylaxis signs. Early management starting in the emergency room is needed to ensure good outcome.
