Atypical intraoperative anaphylactic shock with ECG changes secondary to non-ruptured hepatic hydatid cyst.
A 62-year-old woman was admitted to the hospital for removal of hydatid cyst from the liver. Intraoperatively, the patient suddenly became hypotensive with tachycardia and ST segment elevation. There was no erythema, bronchospasm or desaturation. Anaesthetic agents were stopped and oxygen fraction was increased. In view of the recurrence of hypotension, she was admitted to the intensive care unit (ICU) without completion of surgery. She was successfully resuscitated and acute myocardial infarction was ruled out. She was managed for the possibility of anaphylaxis with hydration, dopamine, antihistamin and hydrocortisone. After stabilisation, she was taken back to the theatre and the cyst was then removed. Histopathology confirmed hydatid disease of the liver. The patient was discharged from the ICU and then from the hospital in 6 days. Anaphylaxis secondary to hydatid disease is uncommon; however, the possibility of such a diagnosis in all patients with non-ruptured hydatid disease in the endemic areas that develop intraoperative shock should be considered.
Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. icu_mariam@yahoo.com
Mariam
M
Alansari
Ibrahim
I
Alsanouri
D000707:Anaphylaxis / Q000209:etiology* / Q000503:physiopathology; D004444:Echinococcosis, Hepatic / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000503:physiopathology; D008099:Liver / Q000473:pathology; D008875:Middle Aged; D013610:Tachycardia / Q000209:etiology / Q000503:physiopathology