title: Intraperitoneal rupture of hydatid cysts.
abstract: OBJECTIVE
  Hydatid cyst rupture into abdominal cavity is a rare but a serious complication. The rupture can occur after a trauma, or spontaneously as a result of increased intracystic pressure. It is a surgical emergency with high morbidity and mortality rates. Early diagnosis and appropriate surgical management of this complication can be life saving. The objective of the current paper is to evaluate the clinical, and radiographic findings and surgical treatment of this complication.
  
  
  METHODS
  A retrospective study on 12 patients operated in our department for intraperitoneal rupture of hydatid cyst between January 1990 and May 2015. We reviewed age, gender, imaging findings, surgical treatment procedures, mortality, morbidity and recurrence.
  
  
  RESULTS
  Our study includes 12 cases of intraperitoneal rupture of hydatid cysts; eight of the patients were men, and four were women. Four patients had a history of abdominal trauma and the other ruptures occurred spontaneously. All the patients had peritoneal irritation signs at presentation. All them underwent ultrasonography and CT scan. Imaging showed intraabdominal free fluid in all of cases. In 11 cases the cyst was unique and only in one case an associated mesenteric hydatid cyst was noted. Ruptured cysts were located in the right lobe of the liver in nine cases, in the left lobe in the other three cases. All the patients underwent emergency surgery after imaging. The procedure applied was conservative associated with drainage in all the cases. Some associated procedures were performed during the same operation. In only one case total pericystectomy for intraperitoneal cyst was performed. There were no post operative deaths. A total of five morbidities developed in three patients (one case of evisceration, three cases of biliary fistula and a case of pulmonary infection).
  
  
  CONCLUSIONS
  Hydatid cyst rupture in peritoneal cavity is a rare complication. Imaging assessment has an important role in diagnosis but clinical signs are mandatory. A quick diagnosis and emergency surgery can decrease postoperative death. Surgery and postoperative care constitute the basis of treatment.
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia. toumiomar2010@yahoo.com.
authors.forename: O
authors.identifier: http://orcid.org/0000-0002-5777-5881
authors.initials: O
authors.lastname: Toumi
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: F
authors.initials: F
authors.lastname: Noomen
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: R
authors.initials: R
authors.lastname: Salem
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: H
authors.initials: H
authors.lastname: Rabeh
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: S B
authors.initials: SB
authors.lastname: Jabra
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: I
authors.initials: I
authors.lastname: Korbi
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Bannani
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: M
authors.initials: M
authors.lastname: Nasr
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: K
authors.initials: K
authors.lastname: Zouari
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: G
authors.initials: G
authors.lastname: Mondher
authors.affiliation: Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
authors.forename: A
authors.initials: A
authors.lastname: Hamdi
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D004443:Echinococcosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012421:Rupture / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: Hepatic hydatid cyst; Rupture; Surgery; Trauma