Spontaneous intraperitoneal rupture of hepatic hydatid cyst in a cirrhotic patient: A diagnostic and therapeutic challenge – A case report

TL;DR

A rare case of a ruptured liver cyst in a cirrhotic patient highlights the diagnostic and treatment challenges of hydatid disease.

Contribution

This case report highlights the rare complication of intraperitoneal rupture of a hepatic hydatid cyst in a cirrhotic patient.

Findings

Intraperitoneal rupture of a hepatic hydatid cyst is rare but severe, especially in cirrhotic patients.

CT scans are crucial for diagnosing ruptured hydatid cysts and guiding treatment decisions.

Surgical intervention combined with albendazole can effectively manage this complication.

Abstract

Hydatid disease, caused by Echinococcus granulosus, is a parasitic condition typically considered benign. However, the rupture of a hepatic hydatid cyst into the abdominal cavity is a rare and potentially fatal complication. This complication is particularly complex in cirrhotic patients, posing significant diagnostic and therapeutic challenges.

We present a case of a 64-year-old woman with a history of poorly managed post-viral cirrhosis due to hepatitis C who presented with abdominal pain lasting for ten days. A computed tomography (CT) scan revealed the rupture of a hydatid cyst in the segment VIII of the liver, associated with a peritoneal reaction. An emergency exploratory laparotomy was performed, confirming the rupture and allowing for the resection of the protruding cyst dome, followed by peritoneal lavage and drainage. No recurrence was observed during a six-month follow-up.

Hydatid disease is endemic in Tunisia and poses a significant public health concern. Although rare (1 to 16 %), intraperitoneal rupture is a severe complication. CT is a key diagnostic tool, offering high sensitivity, especially for differential diagnoses. The management of this condition necessitates urgent surgical intervention, followed by medical treatment with albendazole to prevent recurrence.

This case underscores the rarity of intraperitoneal rupture of a hydatid cyst and emphasizes the importance of considering this complication in the diagnosis of abdominal emergencies in endemic regions, as delayed diagnosis is associated with a particularly poor prognosis.

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