Presentation
Acute abdominal pain.
Patient Data
The right hepatic lobe (segment VIII & VII) shows large three hepatic cysts showing thin imperceptible nonenhancing walls. The subcapsular cyst shows lateral wall defect communicating with peritoneal ascites, impressive of cyst rupture into the peritoneal cavity, with associated mild ascites, and peritoneal/omental thickening and smudging, denoting mild peritonitis.
Case Discussion
Intrahepatic complications of hepatic hydatid cysts include cyst rupture or infection.
Types of cyst rupture:
- contained ruptures occur when the endocyst ruptures but the pericyst remains intact. This appears as floating membranes within the cyst.
- communicating rupture implies the passage of the cyst contents into the biliary radicles.
- direct rupture occurs when both the pericyst and endocyst rupture, allowing free spillage of hydatid material into the peritoneal cavity, pleural cavity, hollow viscera, abdominal wall
Hydatid cyst direct rupture might occur spontaneously, like in this case, or induced might be induced by trauma. It usually occurs near the edge of the liver secondary to deficient pericyst and little liver tissue around it.
Cyst rupture may be clinically silent or might be fatal if it induced anaphylaxis.
Complications of direct hepatic rupture include anaphylaxis or implantation of scoleces leading to diffuse peritoneal hydatidosis