Intraperitoneal rupture of the hydatid cyst: Four case reports and literature review

Abstract

Background: Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons. However, some patients develop symptoms and complications due to cyst size, location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract, vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.

Case summaries: Four patients aged between 27 and 44 years (two men and two women) were admitted to our clinic with sudden abdominal pain (n = 4), hypotension (n = 3), and anaphylaxis (n = 2). Three of the perforated cysts were located in the liver, and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzyme-linked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention (range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up (range: 25-80 mo).

Conclusion: Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.

Keywords: Anaphylactic reactions; Case report; Complication; Hydatid cyst; Inraperitoneal rupture; Spontaneous rupture; Traumatic rupture.

Figure 1

Coronal reformatted contrast-enhanced computed tomography shows that fluid collection and daughter vesicles adjacent to the hydatid cyst located in segment VI of the liver. This finding is consistent with a perforated hydatid cyst.

Figure 2

Axial plane computed tomography of the same patient shows exophytic extension of the giant hydatid cyst located in the right lobe of the liver.

Figure 3

Intraoperative appearance of the hydatid cyst compatible lesion that originated and ruptured from the spleen. This image was taken after aspiration of the hydatid cyst fluid in the abdominal cavity.

Figure 4

Apearance of the spleen and ruptured cyst specimens obtained from the same patient.

Figure 5

Coronal reformatted images of the venous phase of computed tomography shows perforated hydatid cyst located in segment V of the liver. This image also shows fluid collection in the right paracolic area.

Figure 6

Two different coronal reformatted contrast-enhanced computed tomography images of the same patient show a perforated hydatid cyst located in segment III of the liver and fluid collection in the perihepatic/pelvic area.

Figure 7

Intraoperative appearance of severe adhesions similar to sclerosing encapsulating peritonitis in the abdominal cavity secondary to hydatid cyst perforation.

Figure 8

Intraoperative image obtained after evacuating the cystic contents.