%0 Journal Article
%T Spontaneous Intraperitoneal Rupture of a Hepatic Hydatid Cyst with Subsequent Anaphylaxis: A Case Report
%A Benjamin Tinsley
%A Aula Abbara
%A Raghunandan Kadaba
%A Hemant Sheth
%A Gurjinder Sandhu
%J Case Reports in Hepatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/320418
%X Hydatid cyst rupture into the abdomen is a serious complication of cystic hydatid disease of the liver (Cystic Echinococcosis) with an incidence of up to 16% in some series and can result in anaphylaxis or anaphylactoid reactions in up to 12.5% of cases. At presentation, 36¨C40% of hydatid cysts have ruptured or become secondarily infected. Rupture can be microscopic or macroscopic and can be fatal without surgery. Hydatid disease of the liver is primarily caused by the tapeworm Echinococcus granulosus and occurs worldwide, with incidence of up to 200 per 100,000 in endemic areas. Our case describes a 24-year-old Bulgarian woman presenting with epigastric pain and evidence of anaphylaxis. Abdominal CT demonstrated a ruptured hydatid cyst in the left lobe of the liver. A partial left lobe hepatectomy, cholecystectomy, and peritoneal washout was performed with good effect. She was treated for anaphylaxis and received antihelminthic treatment with Albendazole and Praziquantel. She made a good recovery following surgery and medical treatment and was well on follow-up. Intraperitoneal rupture with anaphylaxis is a rare occurrence, and there do not seem to be any reported cases from UK centres prior to this. 1. Introduction Hydatid disease (Echinococcosis) of the liver is a parasitic infection primarily caused by the larvae of the cestode Echinococcus granulosus. This tapeworm is responsible for cystic hydatid disease (Cystic Echinococcosis), which is the most common form [1]. Worldwide incidence is between 1 and 200 per 100,000 [1]. Endemic regions include the Mediterranean littoral (especially Turkey, Greece, Cyprus, and Spain), central Russia, China, and Australasia [1¨C5]. In Bulgaria¡ªour patient¡¯s country of origin¡ªthe annual incidence in children increased from 0.7 per 100,000 in 1971¨C82 to 5.4 in 1995 [1, 4]. The adult cestode develops in the small intestine of the definitive host (most commonly dogs) and releases eggs which are dispersed in the stools of the host [2]. When eggs are ingested by an intermediate host (usually sheep or cattle), embryos are released into the duodenum and pass into the portal and lymphatic systems [2]. Humans act as ¡°aberrant¡± intermediate hosts by accidentally ingesting eggs via infected vegetables or water, or touching dogs with contaminated hair [1, 3]. The most common site for cystic disease is the liver (around 75% [1]); lung (up to 25% [5]) is the second most common site. Less frequently cysts develop in the spleen, kidneys, heart, bones, and central nervous system [4]. The embryo of Echinococcus granulosus develops
%U http://www.hindawi.com/journals/crihep/2013/320418/