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Spontaneous intraperitoneal rupture of hepatic hydatid cyst: a rare cause of ascites.

Limeme M, Yahyaoui S, Zaghouani H, Ghannouchi M, Khnissi A, Amara H, Letaief R, Bakir D, Kraiem C - BMC Surg (2014)

Bottom Line: Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity associated with many intraperitoneal cysts with a scalloping on the liver.A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface.This condition is included in the differential diagnosis of ascites in endemic areas.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Farhat Hached hospital, 4000 Sousse, Tunisia. dr.sana2010@yahoo.fr.

ABSTRACT

Background: Hydatid disease is endemic in certain areas of the world and it is located mostly in the liver. Intraperitoneal rupture is rare. Rupture may result from trauma or may occur spontaneously from increased pressure of the cystic fluid. Ruptured hydatid cyst is a rare cause of ascites, but should be considered in the differential diagnosis, especially in endemic areas. The diagnosis of ruptured hydatid cyst should be prompt because it requires emergency intervention.

Case presentation: The present case refers to a 62 year old Tunisian male admitted in our institution for diffuse abdominal distension. Physical examination was unremarkable except for the presence of ascites. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity associated with many intraperitoneal cysts with a scalloping on the liver. It showed also a heterogeneous cystic lesion of the segment II of the liver. Abdominal computed tomography (CT) revealed in addition a fat infiltration and a thickening of the peritoneum. Thus intraperitoneal hydatid cyst rupture was suspected and emergency laparotomy was performed. A yellow serous fluid , containing many daughter vesicles disseminated through the peritoneal cavity was noted. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface. Thus, intraperitoneal rupture of hepatic hydatid cyst was diagnosed.

Conclusion: The rupture of hydatid cyst into the peritoneal cavity is rare but presents a challenge for the radiologist and the surgeon. This condition is included in the differential diagnosis of ascites in endemic areas.

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Related in: MedlinePlus

Macroscopical findings of the specimen. View of multiple cysts removed from peritoneum (A) and the ruptured liver cyst (B).
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Fig3: Macroscopical findings of the specimen. View of multiple cysts removed from peritoneum (A) and the ruptured liver cyst (B).

Mentions: A 62 year old Tunisian male was hospitalized for exploration of abdominal distension in the preceding two months with progressive aggravation. The patient had no history of trauma, surgery or systemic disease earlier. The patient had no history of trauma, prior surgery or systemic disease. Physical examination found ascites without any other abnormality. The ascitic fluid was thick and yellow with high level of lipids. Because the ascites was so massive and chylous, without any sign of hepatic, cardiac or nephrological disorder, tuberculosis or neoplasic causes were suspected. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity with associated with many intraperitoneal cysts with a scalloping on the liver (Figure 1). It showed also a heterogeneous cystic lesion in the segment II of the liver measuring 3.5 × 2.5 cm. The biliary ducts have a normal calibre. Abdominal computed tomography (CT) before and after intravenous administration of contrast agent revealed in addition a fat infiltration and a thickening of the peritoneum (Figure 2). Thus an intraperitoneal rupture of a hydatid cyst was suspected and an emergency laparotomy was performed. Yellow serous fluid (2000 ml) was noted, containing many daughter vesicles disseminated through the peritoneal cavity. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface (Figure 3). After a partial cystectomy, the cyst pouch was irrigated with hypertonic saline (3%), and the peritoneal cavity was washed with isotonic saline for 10 to 15 minutes. After surgery, the patient was started on albendazole (10 mg/kg) for three months.Figure 1


Spontaneous intraperitoneal rupture of hepatic hydatid cyst: a rare cause of ascites.

Limeme M, Yahyaoui S, Zaghouani H, Ghannouchi M, Khnissi A, Amara H, Letaief R, Bakir D, Kraiem C - BMC Surg (2014)

Macroscopical findings of the specimen. View of multiple cysts removed from peritoneum (A) and the ruptured liver cyst (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4256059&req=5

Fig3: Macroscopical findings of the specimen. View of multiple cysts removed from peritoneum (A) and the ruptured liver cyst (B).
Mentions: A 62 year old Tunisian male was hospitalized for exploration of abdominal distension in the preceding two months with progressive aggravation. The patient had no history of trauma, surgery or systemic disease earlier. The patient had no history of trauma, prior surgery or systemic disease. Physical examination found ascites without any other abnormality. The ascitic fluid was thick and yellow with high level of lipids. Because the ascites was so massive and chylous, without any sign of hepatic, cardiac or nephrological disorder, tuberculosis or neoplasic causes were suspected. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity with associated with many intraperitoneal cysts with a scalloping on the liver (Figure 1). It showed also a heterogeneous cystic lesion in the segment II of the liver measuring 3.5 × 2.5 cm. The biliary ducts have a normal calibre. Abdominal computed tomography (CT) before and after intravenous administration of contrast agent revealed in addition a fat infiltration and a thickening of the peritoneum (Figure 2). Thus an intraperitoneal rupture of a hydatid cyst was suspected and an emergency laparotomy was performed. Yellow serous fluid (2000 ml) was noted, containing many daughter vesicles disseminated through the peritoneal cavity. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface (Figure 3). After a partial cystectomy, the cyst pouch was irrigated with hypertonic saline (3%), and the peritoneal cavity was washed with isotonic saline for 10 to 15 minutes. After surgery, the patient was started on albendazole (10 mg/kg) for three months.Figure 1

Bottom Line: Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity associated with many intraperitoneal cysts with a scalloping on the liver.A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface.This condition is included in the differential diagnosis of ascites in endemic areas.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Farhat Hached hospital, 4000 Sousse, Tunisia. dr.sana2010@yahoo.fr.

ABSTRACT

Background: Hydatid disease is endemic in certain areas of the world and it is located mostly in the liver. Intraperitoneal rupture is rare. Rupture may result from trauma or may occur spontaneously from increased pressure of the cystic fluid. Ruptured hydatid cyst is a rare cause of ascites, but should be considered in the differential diagnosis, especially in endemic areas. The diagnosis of ruptured hydatid cyst should be prompt because it requires emergency intervention.

Case presentation: The present case refers to a 62 year old Tunisian male admitted in our institution for diffuse abdominal distension. Physical examination was unremarkable except for the presence of ascites. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity associated with many intraperitoneal cysts with a scalloping on the liver. It showed also a heterogeneous cystic lesion of the segment II of the liver. Abdominal computed tomography (CT) revealed in addition a fat infiltration and a thickening of the peritoneum. Thus intraperitoneal hydatid cyst rupture was suspected and emergency laparotomy was performed. A yellow serous fluid , containing many daughter vesicles disseminated through the peritoneal cavity was noted. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface. Thus, intraperitoneal rupture of hepatic hydatid cyst was diagnosed.

Conclusion: The rupture of hydatid cyst into the peritoneal cavity is rare but presents a challenge for the radiologist and the surgeon. This condition is included in the differential diagnosis of ascites in endemic areas.

Show MeSH
Related in: MedlinePlus