[Intraoperative hydatid anaphylactic shock]

Certain parts of Spain continue to have a high incidence of hydatid disease. Anaphylaxis mediated by IgE, due to the high concentration of antigens in the blood stream, is a serious but fortunately infrequent complication of surgery. We present two cases of anaphylactoid reaction in patients undergoing surgery for excision of hydatid cysts and one case of a patient scheduled for cholecystectomy with unsuspected hydatid disease. This represents three cases presenting vascular collapse accompanied by metabolic acidosis, from among a total of 53 surgical patients handled by our department between January 1992 and May 1993. Early, essentially clinical, diagnosis and immediate start of treatment with adrenaline, suspension of inhaled anesthetics, administration of 100% oxygen, and restoration of intravascular volume with colloids or crystalloids were decisive in assuring the favorable outcome for these patients. Hydatid disease must be considered as a differential diagnosis in cases of shock during surgery in areas where it is endemic. Although infrequent, the possibility of anaphylaxis must be kept in mind whenever there is sudden hemodynamic deterioration during surgery for removal of a hydatid cyst. Early diagnosis and appropriate treatment are essential for a favorable outcome.