Intraperitoneal rupture of the hydatid cyst disease: Single-center experience and literature review

BACKGROUND: The primary aim of this study was to present our experience on intraperitoneal rupture of the hydatid cyst in guidance of literature data.
METHODS: Demographical, clinical, radiological and postoperative follow-up data of 29 patients who underwent surgical treatment in our institution with an indication of intraperitoneal rupture of the hydatid cyst from January 2003 to July 2020 were analysed retropectively.
RESULTS: Among the 29 patients with an age range of from 16 to 79 years ( median= 39, IQR=25.5), 16 were male (55.2%) and 13 were female (44.8%). Intraperitoneal rupture of the hydatid cyst was spontaneous in 21 (72.4%), traumatic in 7 (24.13%) (2 of them were iatrogenic) and was due to shotgun in one patient. Vast majority of the patients were admitted to the emergency department in the first 24 hours after the onset of sign and symptoms. WBC varied from 8.600 to 30.900/mm3 (median=12.100, IQR=5.7). Ruptured cysts were localised in liver (n=25, 86.2%), in spleen (n=2, 6.89%) or in pelvis (n=2, 6.89%) and diameter varied from 40 to 200 mm (median= 90, IQR=50). Among the cysts ruptured in liver, 19 (76%) of them were localised in right lobe. Among the ruptured cysts of liver, 20 (80%) of them underwent conservative surgery (partial pericystectomy etc), remaining 5 patients (20%) underwent a radical surgical treatment (pericystectomy etc). A biliary orifice was diagnosed during surgical exploration in either cyst cavity or cut surface of liver in 12 (48%) of the patients. Patients with a dilated common bile duct or a visible biliary duct orifice in cystic cavity underwent common bile duct exploration and T-tube drainage procedure (n=6, 24%). One patient died on postoperative day one, due to cardiopulmonary complications secondary to cyst rupture. All along the postopeartive follow-up of median 1416 days, seven (24.1%) patients were diagnosed for diseased recurrence.
CONCLUSION: Intraperitoneal rupture of the hydatid cyst is a life-threatening complication of hydatid cyst disease, for which diagnosis without delay and timing of surgical treatment is essential. Anaphylactic shock cases require rapidly initiation of medical treatment against allergic reactions. Despite scolocidal agents, vesicular spread into peritoneal cavity account for the major risk factor for disease recurrence. Hence, abdominal cavity should be explored cautiously.

Hidatik kist hastalýðýnýn periton içine rüptürü: Tek merkez deneyimi ve literatür analizi

AMAÇ: Bu çalýþmanýn amacý intraperitoneal hidatik kist rüptürü geliþen hastalarla ilgili merkezimizin deneyimlerini literatür verileri ýþýðýnda sunmaktýr.
GEREÇ VE YÖNTEM: Ocak 2003 ile Temmuz 2020 tarihleri arasýnda kliniðimiz tarafýndan intraperitoneal hidatik kist rüptürü sebebiyle ameliyat edilen 29 hastanýn demografik, klinik, radyolojik ve postoperatif takip verileri retrospektif olarak incelendi.
BULGULAR: Yaþlarý 16 ile 79 yýl (median: 39, IQR=25.5) arasýnda deðiþen 29 hastanýn 16 (55.2%)’sý erkek ve 13’ü kadýn idi. Hastalarýn 21(72.4%)’inde spontaneous, 7’sinde travmatik (iatrogenic=2) ve birinde ateþli silah yaralanmasýna baðlý hidatik kist rüptürü geliþti. Hastalarýn çoðu semptom ve bulgularýn baþlamasýndan sonraki ilk 24 saat içinde acil servise baþvurmuþtu. WBC sayýlarý 8.600 ile 30.900/mm3 (median=12.100, IQR=5.7) arasýnda deðiþmekteydi. Rüptüre kistlerin 25 (86.2%)’i karaciðer, 2’si dalak ve geriye kalan 2’si pelvis lokalizasyonundaydý. Karaciðerde rüptüre olan kistlerin 19 (76%)’u sað lob lokalizasyonundaydý. Rüptüre kistlerin çaplarý 40 ile 200 mm (median= 90, IQR=50) arasýnda deðiþmekteydi. Karaciðer yerleþimli rüptüre kistlerin 20 (80%)’sine konservatif cerrahi (partial pericystectomy gibi) iþlem uygulanýrken geriye kalan 5 (20%) hastaya radikal cerrahi (pericystectomy gibi) iþlem uygulandý. Cerrahi iþlem sýrasýnda karaciðer yerleþimli rüptüre kistlerin 12 (48%)’inde kist kavitesinde veya karaciðer kesi yüzeyinde safra orifisi tespit edildi. Koledok çapý geniþ olan veya kist kavitesinde geniþ safra orifisi olan 6 (24%) hastaya koledok explorasyonu ve t-tube drenaj iþlemi uygulandý. Bir hasta kist rüptürüne sekonder kardiopulmoner komplikasyonlar sebebiyle postoperatif birinci günde kaybedildi. Postoperatif median 1416 günlük takipte 7 (24.1%) hastada nüks geliþti.
TARTIÞMA: Intraperitoneal rüptür hidatik kist hastalýðýnýn hayatý tehdit eden bir komplikasyonudur. Hýzlý taný ve cerrahi tedavinin zamanlamasý hayati önem arz eder. Anaflaktik komplikasyon geliþen hastalarda allerjik reaksiyonlara yönelik medikal tedaviye olabildiðince hýzlýca baþlanmalýdýr. Her ne kadar skolosidal ajanlar kullanýlsa bile rüptür sonucunda periton boþluðuna dökülen kýz veziküller daha sonra nüks geliþmesi için en önemli risk faktörüdür. Bu yüzden tüm karýn boþluðu itina ile kontrol edilmelidir.