Traumatic intraperitoneal rupture of a hepatic hydatid cyst presenting as refractory anaphylactic shock: a rare case...

Traumatic rupture of a hepatic hydatid cyst is an exceptionally rare and life-threatening surgical emergency, particularly in endemic regions as Kurdistan region, Iraq. We report the case of a 19-year-old male who presented with acute right upper quadrant pain following an initially undisclosed abdominal assault. Despite unremarkable initial radiographs and laboratory investigations, bedside point-of-care ultrasound and subsequent computed tomography revealed a ruptured hepatic hydatid cyst with the characteristic 'water lily sign'. The patient rapidly developed severe anaphylactic shock, requiring aggressive resuscitation with adrenaline and corticosteroids. Emergency laparotomy confirmed a ruptured hepatic hydatid cyst, which was managed with germinal layer removal, deroofing, and peritoneal irrigation. The patient made an uneventful recovery and remains disease-free at 30-month follow-up. This case underscores that anaphylaxis may be the primary manifestation of occult hydatid disease following trauma, necessitating a high index of clinical suspicion even in the absence of a known history.