Toumi O, Noomen F, Salem R, Rabeh H, Jabra S B, Korbi I, Bannani S, Nasr M, Zouari K, Mondher G, Hamdi A
Department of Surgery and Radiology, Fattouma Bourguiba Hospital, 5000, Monastir, Tunisia.
Eur J Trauma Emerg Surg. 2017 Jun;43(3):387-391. doi: 10.1007/s00068-016-0662-9. Epub 2016 Mar 23.
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.
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.
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).
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.
包虫囊肿破裂入腹腔是一种罕见但严重的并发症。破裂可发生于外伤后，或因囊内压升高而自发破裂。这是一种外科急症，发病率和死亡率都很高。对该并发症进行早期诊断并采取适当的手术治疗可挽救生命。本文的目的是评估该并发症的临床、影像学表现及手术治疗情况。
对1990年1月至2015年5月间在我科接受手术治疗的12例包虫囊肿腹腔内破裂患者进行回顾性研究。我们回顾了患者的年龄、性别、影像学表现、手术治疗过程、死亡率、发病率及复发情况。
我们的研究包括12例包虫囊肿腹腔内破裂病例；其中8例为男性，4例为女性。4例患者有腹部外伤史，其他破裂为自发发生。所有患者就诊时均有腹膜刺激征。所有患者均接受了超声检查和CT扫描。影像学检查显示所有病例腹腔内均有游离液体。11例囊肿为单发，仅1例发现伴有肠系膜包虫囊肿。破裂囊肿位于肝右叶9例，左叶3例。所有患者在影像学检查后均接受了急诊手术。所有病例均采用保守手术并联合引流。在同一手术中还进行了一些相关操作。仅1例患者因腹腔内囊肿行全囊肿切除术。术后无死亡病例。3例患者共出现5种并发症（1例脏器脱出、3例胆瘘和1例肺部感染）。
包虫囊肿腹腔内破裂是一种罕见的并发症。影像学评估在诊断中起重要作用，但临床体征也必不可少。快速诊断和急诊手术可降低术后死亡率。手术及术后护理是治疗的基础。
