Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
LETTER TO EDITOR  
Year : 2020  |  Volume : 13  |  Issue : 2  |  Page : 171-172
Case of anaphylactic shock after ruptured hydatid cyst of liver: A nightmare to emergency physicians


Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India

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Date of Submission19-Jan-2020
Date of Decision21-Jan-2020
Date of Acceptance30-Jan-2020
Date of Web Publication10-Jun-2020
 

How to cite this article:
Gupta N, Katiyar R, Singh VK. Case of anaphylactic shock after ruptured hydatid cyst of liver: A nightmare to emergency physicians. J Emerg Trauma Shock 2020;13:171-2

How to cite this URL:
Gupta N, Katiyar R, Singh VK. Case of anaphylactic shock after ruptured hydatid cyst of liver: A nightmare to emergency physicians. J Emerg Trauma Shock [serial online] 2020 [cited 2020 Sep 25];13:171-2. Available from: http://www.onlinejets.org/text.asp?2020/13/2/171/286228




Dear Editor,

Hydatidosis, due to infection with the metacestode of Echinococcus granulosus, is a silent zoonotic disease with worldwide distribution. The most common sites of cysts are the liver and lung.[1] Hydatid cyst not only may remain symptomless for years but also may show pressure symptoms due to the growth, rupture to the neighboring structures, or becoming contaminated with infection.[2] Spontaneous intraperitoneal rupture of a cyst, although rare (1%–8%), is life-threatening.[3] Patients with hydatid cyst rupture into the peritoneal cavity are often admitted to the emergency department with an acute abdomen. The diagnosis is established by ultrasonography and computed tomography (CT). Anaphylactic reactions are rare presentations of ruptured pulmonary hydatid cyst.[4] In our case, the hepatic cyst which led to anaphylaxis after rupture and was treated successfully. A 57-year-old woman admitted to the emergency department in shock with respiratory distress. She had urticaria, erythema, and rashes all over the body. There was no history of trauma, fever, cough, chest pain, or hemoptysis. Her abdominal CT revealed a collapsed germinative membrane and widespread intra-abdominal free fluid. She was diagnosed to have ruptured hydatid cyst of the liver and planned for emergency laparotomy. Her blood pressure, pulse, oxygen saturation, and temperature were 80/52 mmHg, 133 beats/min, 80%, and 38.7°C, respectively. The white blood cell count, hemoglobin, hematocrit, and platelet count were 24,300/mm3, 11.9 mg/dL, 34.5 g/dL, and 332,000/mm3, respectively. Other biochemical parameters including serum procalcitonin level were within the normal range. Rapid sequence endotracheal intubation was done and put ultrasound-guided central line and arterial line. Vasopressors support started. The patient was not extubated postoperatively and kept in the ICU for further management. Despite fluid resuscitation and vasopressor therapy, her blood pressure was on the lower side. On auscultation, there was bilateral wheeze all over lung fields. Blood gases showing hypoxemia with severe metabolic acidosis. We started treatment in the line of anaphylactic shock. Adrenaline infusion started along with bolus steroid injection. Rashes disappeared and oxygenation improved still there were signs of organ hypoperfusion (high base deficit and lactate levels). Then, we gave bolus dose of Vitamin C (1.5 g iv) and thiamine (100 mg iv). There was tremendous improvement in blood pressures and organ perfusion within fraction of time. The patient extubated and shifted to ward after 24 h of surgery.

In this way, we can consider the role of the high dose of Vitamin C and thiamine injections to increase the responsiveness of endothelium to vasopressors therapy in case of anaphylactic shock.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Eckert J. WHO/OIE Manual on Echinococcosis in Humans and Animals: A Public Health Problem of Global Concern. Geneva: WHO/OIE: 2001.  Back to cited text no. 1
    
2.
Rostami A, Mozafari M, Gholipourmalekabadi M, Caicedo HH, Lasjerdi Z, Sameni M, et al. Optimization of fluoride-containing bioactive glasses as a novel scolicidal agent adjunct to hydatid surgery. Acta Trop 2015;148:105-14.  Back to cited text no. 2
    
3.
Ray S, Das K. Spontaneous intraperitoneal rupture of hepatic hydatid cyst with biliary peritonitis: A case report. Cases J 2009;2:6511.  Back to cited text no. 3
    
4.
Bensghir M, Fjouji S, Bouhabba N, Ahtil R, Traore A, Azendour H, et al. Anaphylactic shock during hydatid cyst surgery. Saudi J Anaesth 2012;6:161-4.  Back to cited text no. 4
    

Top
Correspondence Address:
Vipin Kumar Singh
Department of Anesthesiology, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_2_20

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