Blunt Abdominal Trauma With Unexpected Anaphylactic Shock Due
To Rupture Of Hepatic Hydatid Cysts
Z Doganay, H Guven, D Aygun, L Altintop, M Yerliyurt,
T Deniz
Departments of Anesthesiology and reanimation,
General Surgery, Neurology, Internal Medicine and Emergency Medicine,
Faculty of Medicine, University of Ondokuzmayis, Samsun, Turkey
Corresponding address: Dr. Zahide Doganay,
Assistant Professor, Emergency Department, Ondokuzmayis University,
55139 Samsun, Turkey. Email: zahidedoganay@yahoo.com
Abstract
Hydatid disease, caused by the cestode Echinococcus,
is common in Mediterranean regions. Depending on its size, an
intact cyst may be ‘silent’ or may compress adjacent
organs, causing symptoms. The cystic stage of Echinococcus granulosus
is commonly located in the liver, which frequently results in
a long symptom-free period. Rupture of a hydatid cyst commonly
gives rise to allergic phenomena, including anaphylactic shock.
Anaphylactic reactions due to hydatid cyst perforation usually
occur during needle aspiration or open cyst surgery, as previously
reported. However, spillage of cyst fluid with intra-peritoneal
rupture due to trauma may trigger anaphylaxis, although case reports
of this are very rare.
We report the case of a 12-year-old female who
was admitted to our Emergency Department with abdominal trauma
and survived anaphylactic shock due to traumatic spillage of hepatic
hydatid cyst fluid. The initial indication of the cysts was confirmed
with a focused abdominal sonogram for trauma (FAST). Essential
life support measures were taken in the Emergency Department using
oxygen, hydration, adrenalin and steroids. The paediatric surgeons
who operated on her removed the cysts and washed out the peritoneal
cavity, and her clinical condition stabilized within 24 h. The
patient was treated with Albendazole (Methyl-5’propylthio-2-benzimidazole
carbamate) for 4 weeks, and she was still healthy 1 year after
the accident.
Key words
Abdominal trauma, hydatid cyst, anaphylaxis
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