Journal of Emergencies, Trauma, and Shock
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Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 117
Ruptured hydatid cyst into the peritoneal cavity: An ultimate multidisciplinary emergency


General Surgery Department, Jendouba Regional Hospital, Jendouba, Tunisia

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Date of Submission29-Oct-2020
Date of Acceptance30-Nov-2020
Date of Web Publication25-Jun-2021
 

How to cite this article:
Mejri A, Arfaoui K. Ruptured hydatid cyst into the peritoneal cavity: An ultimate multidisciplinary emergency. J Emerg Trauma Shock 2021;14:117

How to cite this URL:
Mejri A, Arfaoui K. Ruptured hydatid cyst into the peritoneal cavity: An ultimate multidisciplinary emergency. J Emerg Trauma Shock [serial online] 2021 [cited 2021 Jul 31];14:117. Available from: https://www.onlinejets.org/text.asp?2021/14/2/117/190164




Sir,

Hydatid disease is an often-called silent and benign cosmopolitan zoonotic infection caused by the larval stage of Echinococcus parasite.[1]

The rupture of the hepatic hydatid cyst to the abdominal cavity though, is a rare but life-threatening emergency that may completely change the course of this disease.

We carried out a descriptive retrospective analysis over 7 years in a reference center located in a highly endemic region, including a total number of nine cases of ruptured liver hydatid cyst into the abdominal cavity.

The average age was 38 years. Two patients were admitted with abdominal trauma. An acute abdominal pain of a sudden onset was the chief complaint in all patients. One patient had an anaphylactic shock. Abdominal computed tomography (CT) played a key role in establishing the diagnosis in hemodynamically stabilized patients. It showed discontinuity in the wall of the cysts associated with intra peritoneal fluid. All cyst were larger than 7 cm with an average size of 11, 2 cm and they all had a protruding dome and spread to two or more liver segments. Prompt compulsory resuscitation measures were early initiated in the emergency room. Then, all patients underwent emergency unroofing surgical procedures associated with intra-operative peritoneal lavage and external drainage. Only one patient had an abscess in a non-declivitous residual cavity successfully treated with CT-guided percutaneous drainage. All patients had albendazol-based therapy during 12 months following surgery. No cases of secondary peritoneal hydatidosis were reported.

These data undoubtedly emphasize the need to consider liver hydatid rupture as a differential diagnosis in every case of an acute abdominal pain. Close collaboration between emergency physicians, anesthetists, and surgeons is the only guarantee of a good outcome. It also focuses on the significant value of modern radiology with its high-resolution multiplanar-reconstruction images as a powerful diagnostic tool. The treatment remains above all surgery. In this emergency context, it seems to be reasonable to go for a conservative technique since it shortens the operative time and poses a negligible risk of bleeding. Toumi et al. prefer not to use hypertonic-saline solution for the intra-operative peritoneal lavage due to its possible complications, such as hypernatremia.[2] However, other authors strongly advocate the use of this scolicidal solution.[1],[3],[4] We did not encounter any complication related to its use in any case in our study. Appropriate resuscitation measures must be started without delay in the emergency room and should be continued postoperatively.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for 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.
Akbulut S, Ozdemir F. Intraperitoneal rupture of the hydatid cyst: Four case reports and literature review. World J Hepatol 2019;11:318-29.  Back to cited text no. 1
    
2.
Toumi O, Noomen F, Salem R, Rabeh H, Jabra SB, Korbi I, et al. Intraperitoneal rupture of hydatid cysts. Eur J Trauma Emerg Surg 2017;43:387-91.  Back to cited text no. 2
    
3.
Mouaqit O, Hibatallah A, Oussaden A, Maazaz K, Taleb KA. Acute intraperitoneal rupture of hydatid cysts: A surgical experience with 14 cases. World J Emerg Surg 2013;8:28.  Back to cited text no. 3
    
4.
Sabzevari S, Badirzadeh A, Shahkaram R, Seyyedin M. Traumatic rupture of liver hydatid cysts into the peritoneal cavity of an 11-year-old boy: A case report from Iran. Rev Soc Bras Med Trop 2017;50:864-7.  Back to cited text no. 4
    

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Correspondence Address:
Atef Mejri
BP 294 Bousalem 8170
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_162_20

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