Acute intraperitoneal rupture of hydatid cysts.
BACKGROUND
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.


METHODS
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.


RESULTS
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%).


CONCLUSIONS
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.
Derici
Hayrullah
H
Third Surgical Clinic of Atatürk Training and Research Hospital, Izmir, Turkey. hayrullahderici@yahoo.com
Tansug
Tugrul
T
Reyhan
Enver
E
Bozdag
Ali Dogan
AD
Nazli
Okay
O
D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D000368:Aged; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity; D012189:Retrospective Studies; D012421:Rupture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000601:surgery