Pasqualini Massimo, Percivale Andrea, Gandini Alessandro, Baldo Stefano, Saccomani Giovanni, Giusto Franco, Profeti Alberto, Santoro Pietro, Pellicci Riccardo
Dipartimento di Chirurgia, Struttura Semplice Chirurgia di Urgenza, Azienda Ospedaliera "Ospedale Santa Corona", Pietra Ligure, Savona.
Chir Ital. 2007 Nov-Dec;59(6):867-72.
Hydatidosis due to Echinococcus granulosus is an endemic parasitic disease in Mediterranean countries. The most frequent anatomical locations are the liver and lung and the most significant complication of liver hydatidosis is rupture into the biliary tract. Spontaneous rupture into the free peritoneal cavity associated with thoracic involvement is an unusual complication accompanied by a high mortality rate. An isolated abdominal approach is necessary when peritoneal cavity drainage is required and may be sufficient in cases of contamination of the pleural cavity by scolices without suppurative involvement. An unusual case of spontaneous rupture of a hydatid cyst of the liver into the free peritoneal cavity associated with diaphragmatic and pleural involvement is reported. This complication requires immediate surgical treatment consisting in a combined thoracic and abdominal approach. The isolated abdominal approach not requiring thoracotomy may be satisfactory if there is no intrathoracic damage due to the chronic presence of scolices. Intrabdominal and intrathoracic cyst rupture still remains a serious complication because of the complexity of the lesions which are often difficult to treat in a one-stage operation. The mortality remains high in various series.
由细粒棘球绦虫引起的包虫病是地中海国家的一种地方性寄生虫病。最常见的解剖部位是肝脏和肺，肝包虫病最严重的并发症是破裂进入胆道。自发破裂进入游离腹腔并伴有胸腔受累是一种不常见的并发症，死亡率很高。当需要进行腹腔引流时，采用单纯腹部入路是必要的，对于棘球蚴污染胸腔但无化脓性病变的病例可能就足够了。本文报告了一例罕见的肝包虫囊肿自发破裂进入游离腹腔并伴有膈肌和胸腔受累的病例。这种并发症需要立即进行手术治疗，采用胸腹联合入路。如果由于棘球蚴的长期存在而没有胸腔内损伤，不需要开胸的单纯腹部入路可能是令人满意的。由于病变复杂，腹腔内和胸腔内囊肿破裂仍然是一种严重的并发症，通常难以在一期手术中治疗。在各种病例系列中，死亡率仍然很高。
