Acute Intraperitoneal Rupture of Hydatid Cysts
Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention.
Seventeen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 18 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively.
Five cases (29.4%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases. Intraperitoneal multiple cysts with heterogeneous cavity or cystic structures in the liver were shown in 14 cases. Computed tomography and magnetic resonance imaging showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Four patients (23.5%) died in the early postoperative period. A total of nine morbidities developed in six patients (35.3%). Median hospital stay was 18 days and median follow-up was 78 months. Intra-abdominal recurrence occurred in one case (7.7%).
Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. Computed tomography scan, in addition to clinical presentation, is essential for diagnosis. Emergency surgery is the main treatment for acute ruptured hydatid cysts. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.
- 3.Bozdag AD, Derici H, Peker Y, et al. Surgical treatment of hydatid cysts of the liver. Insizyon Cerrahi Tıp Bilimleri Dergisi, 2000;3:216–219Google Scholar
- 4.Barnes SA, Lillemoe KD. Liver abscess and hydatid cyst disease. In Zinner MJ, Schwartz SI, Ellis H, editors, Maingot’s Abdominal Operations, 10th ed, Stamford, CT, Appleton & Lange, 1997:1513–1545Google Scholar
- 15.Paraskevopoulos JA, Baer H, Dennison AR. Liver hydatid disease audit of surgical management. Int J Surg Sci 1998;5:21–24Google Scholar
- 16.Garcia JIL, Alonso E, Gonzales-Uriarte J, et al. Evaluation of scolicidal agents in an experimental hydatid disease model. Eur Surg Res 1997;29:202–208Google Scholar
- 22.Kaymak E, Tansug T, Denecli AG, et al. Postoperative recurrence of hydatid disease of the liver and prophylaxis with mebendazole. Arch Hidatidosis 1991;30:1221–1225Google Scholar