SciELO - Scientific Electronic Library Online

 
vol.102 número8Loeys-Dietz syndrome: a possible solution for Akhenaten's and his family's mystery syndromeSolar ultraviolet radiation exposure and human health in South Africa: finding a balance índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Artigo

Indicadores

    Links relacionados

    • Em processo de indexaçãoCitado por Google
    • Em processo de indexaçãoSimilares em Google

    Bookmark

    SAMJ: South African Medical Journal

    versão impressa ISSN 0256-9574

    SAMJ, S. Afr. med. j. v.102 n.8 Cape Town ago. 2012

     

    FORUM
    CLINICAL IMAGES

     

    Ascites as an initial presentation of spontaneously ruptured hydatid cyst

     

     

    Ibrahim Halil Turkbeyler; Taner Babacan; Ismail Dilli; Ayhan Balkan; M Sait Dag; Abdurrahman Kadayifçi

    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 Kadayifçi are from the Department of Gastroenterology

    Correspondence to

     

     


    ABSTRACT

    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.


     

     

    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.

    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.

     

    References

    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.        [ Links ]

    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.        [ Links ]

     

     

    Accepted 23 April 2012.

     

     

    Correspondence to:
    IH Turkbeyler
    (turkbeyler@mynet.com)