Intraperitoneal ruptured hydatid cyst of liver with cystobiliary communication: A case report

Introduction and importance: Hydatid disease, caused by Echinococcus larvae, leads to cystic echinococcosis, primarily affecting the liver and lungs. It is common in endemic regions like Argentina and East Africa, with incidences of over 50 cases per 100,000 people. A rare and life-threatening complication is the intraperitoneal rupture of a hydatid cyst. Case presentation: A 38-year-old female presented with epigastric pain followed by sudden-onset abdominal pain and hypotension. Lab results showed elevated white blood cell count with a high eosinophil. Ultrasonography (USG) and Computed Tomography (CT) scans showed a large, ruptured hydatid cyst of the liver. Emergency laparotomy revealed a ruptured hydatid cyst at the anterosuperior aspect of the liver. The intracystic collection was aspirated, and the cyst cavity and peritoneal cavity were washed with 20 % warm hypertonic saline. Postoperatively, albendazole treatment was started. Follow-up evaluations at 1, 3, and 6 months showed no evidence of recurrence on radiological scans. Clinical discussion: Intraperitoneal rupture of hydatid cysts is a rare yet life-threatening complication, accounting for 1-16 % of cases. USG and Contrast-Enhanced CT (CECT) of the abdomen are the mainstays for diagnosis, and magnetic resonance cholangiopancreatography (MRCP) helps detect cystobiliary communication. Treatment includes stabilization, surgical cyst evacuation, and scolicidal irrigation. Postoperative albendazole therapy, along with regular follow-up, is essential to prevent recurrence. Conclusion: Spontaneous rupture of hepatic hydatid cyst with cystobiliary communication is a rare but critical condition, especially in endemic areas, presenting with acute abdomen and shock. Lifesaving emergency laparotomy followed by comprehensive postoperative care is vital for preventing complications and recurrence.