Ascites as an initial presentation of spontaneously ruptured hydatid cyst.
We describe the diagnosis of a 77-year-old woman admitted to our
outpatient department with a 3-month history of abdominal bloating and
distension. Abdominal computed tomography revealed a large cystic lesion
in the posterior segment of the right hepatic lobe, with a separated
germinal layer and widespread ascites with dense internal echoes and
septal appearance. The result of a serum Echinococcus indirect
haemagglutination test was positive and findings were indicative of the
spontaneous rupture of a hydatid cyst into the peritoneal cavity without
trauma. Ascites is rarely seen in the course of hydatid disease, but can
result from cyst rupture into the peritoneal cavity. This should be
considered in the differential diagnosis of ascites, especially in areas
such as Turkey, where hydatid disease in endemic.
S Afr Med J 2012;102(8):664. DOI: 10.7196/SAMJ.5935
(Care and treatment)
Echinococcosis (Care and treatment)
Turkbeyler, Ibrahim Halil
|Publication:||Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 South African Medical Association ISSN: 0256-9574|
|Issue:||Date: August, 2012 Source Volume: 102 Source Issue: 8|
|Geographic:||Geographic Scope: South Africa Geographic Code: 6SOUT South Africa|
Hydatid disease is a common parasitic infection of the liver with
Echinococcus granulosus. Complications include rupture into the biliary
tree, peritoneum and chest, secondary infection, anaphylactic shock and
sepsis. (1) Ascites, although rare in the course of hydatid disease, can
result from cyst rupture into the peritoneal cavity. (2)
A 77-year-old woman was admitted to our outpatient department complaining of abdominal bloating and distension in the preceding 3 months. The patient had lost weight and had appetite-associated nausea, with no history of jaundice. Her physical examination was unremarkable except for the presence of ascites. Serum-ascites albumin gradient (SAAG) was 0.4--compatible with nonportal hypertensive ascites. The ascitic fluid showed no bacterial or tuberculosis infection and the cytological examination was negative for malignancy. Abdominal computed tomography (CT) revealed a large cystic lesion in the posterior segment of the right hepatic lobe, with a separated germinal layer and widespread ascites with dense internal echoes and septal appearance (Fig. 1).
The result of a serum Echinococcus indirect haemagglutination test was positive. The patient was diagnosed with spontaneous rupture of a hydatid cyst into the peritoneal cavity without trauma. Treatment with albendazol (10 mg/kg/day) was initiated and emergency surgical exploration was suggested. However, the patient refused surgery and was lost to follow-up.
[FIGURE 1 OMITTED]
Ruptured hydatid cyst is a rare cause of ascites, but should be considered in differential diagnosis, especially in endemic areas such as Turkey. Because rupture of an hepatic hydatid cyst into the peritoneal cavity can lead to an acute abdomen with chemical or bacterial peritonitis, it can be fatal without appropriate surgical management.
Accepted 23 April 2012.
(1.) Avgerinos ED, Pavlakis E, Stathoulopoulos A, Manoukas E, Skarpas G, Tsatsoulis P. Clinical presentations and surgical management of liver hydatidosis: our 20 year experience. HPB (Oxford) 2006;8(3):189-193.
(2.) Okan V, Araz M, Demirci F, Micozkadioglu H, Ozkur A. Hydatid cyst: a rare cause of ascites. Comput Med Imaging 2002:26(5):357-359.
All authors hail from the Gaziantep University School of Medicine, Turkey: Ibrahim Halil Turkbeyler, Taner Babacan and Ismail Dilli are from the Department of Internal Medicine, and Ayhan Balkan, M Sait Dag, Abdurrahman Kadayifci are from the Department of Gastroenterology.
Corresponding author: I H Turkbeyler (email@example.com)
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