Faik TATLI, Orhan GÖZENELİ, Yusuf YÜCEL, ALİ UZUNKÖY, Hüseyin Cahit YALÇIN, Yalçın OZGÖNÜL, Abuzer DİRİCAN

Acute Abdomen Caused by Spontaneous Perforation of Hydatid Liver Cyst

Amaç: Bu çalışmada, kist hidatik hastalığının endemik olduğu bölgemizde, karaciğer kist hidatiğinin spontan perforasyonlarına bağlı olarak gelişen akut batın olguları değerlendirmeyi amaçladık. Yöntemler: Kliniğimizde 01.01.2012 ile 01.08.2016 tarihleri arasında opere edilen toplam 218 kist hidatik hastasının dosyaları geriye dönük olarak incelendi. Karaciğer kist hidatik rüptürü nedeniyle acil olarak operasyona alınan 12 (%5,5) vaka çalışmaya dâhil edildi. Olgular yaş, cinsiyet, mevcut semptomları, radyolojik bulguları, laboratuvar sonuçları ve postoperatif takipleri yönünden değerlendirmeye alındı. Sonuçlar: Çalışmaya alınan 12 hastanın 10 (%83,3)'u kadın, 2 (%16,7)'si erkekti, ortalama yaşları 40.4 yıl idi. Olguların hepsinde spontan rüptür mevcuttu. Hastaların 11'inde tek kist, bir hastada ise multiple kist mevcuttu. Dokuz hastaya ultrasonografi (US), üç hastaya ise bilgisayarlı tomografi (CT) ile tanı kondu. Sonuç olarak, kist hidatik hastalığının endemik olduğu bölgelerde, akut batın nedenleri arasında kist hidatik rüptürü de düşünülmelidir. Karaciğerde, periferik yerleşimli ve tek kisti olan hastalarda spontan perforasyon riskinin yüksek olduğunu düşünüyoruz. Kist hidatik rüptürü tanısı konulan hastalar, acil olarak operasyona alınmalı ve ameliyat sonrası medikal tedavi başlanmalıdır.

Karaciğer Hidatik Kistinde Spontan Perforasyonun Neden Olduğu Akut Karın

Objectives: The aim of this study was to evaluate acute abdomen cases that developed as a result of spontaneous perforations of hydatid liver cysts in our regions, where hydatid cyst disease is endemic. Methods: The records of 218 hydatid cyst patients who underwent surgery at our clinic between 01.01.2012 and 01.08.2016 were retrospectively reviewed. Twelve (5.5%) cases who required emergency surgery due to the rupture of hydatid cysts were included in this study. The cases were reviewed with respect to age, sex, current symptoms, radiological findings, laboratory results and post-operative results. Results: Ten (83.3%) of the 12 patients were females, and two (16.7%) were males, and their mean age was 40.4 y (23-69). All patients with spontaneous perforations had hydatid liver cysts. Eleven of the patients had a single cyst, and one had multiple cysts. Nine patients were diagnosed with ultrasonography (US), and three patients were diagnosed with computed tomography (CT) Conclusions: Hydatid cystic rupture should be considered in cases of an acute abdomen in regions where hydatid cystic disease is endemic. We believe that patients with a single cyst that is peripherally located in the liver have a high risk of spontaneous perforation. Patients who are diagnosed with hydatid cystic rupture should undergo emergency surgery, followed by medical treatment.

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1. Kayaalp C. Hydatid cyst of liver. In: Blumgart LH, Belghiti RJ, DeMatteo RP, Chapman WC, Büchler MW, Hann LE, D'Angleca M, eds. Surgery of liver, biliary tract, and pancreas, 4th edn. Philadelphia: Saunders Elsevier 2007;952-70.
2. Sayek I, Yalın R, Sanaç Y. Surgical treatment of hydatid desease of liver. Arch Surg 1980; 115:847-50.
3. Barnes SA, Lillemoe KD. Liver abscess and hydatid cyst disease. In: Zinner MJ, Schwartz SI, Ellis H, editors. Maingot's Abdominal Operations. 10th ed. Stamford (CT): Appleton& Lange 1997;1513-45.
4. Filice C, Brunetti E. Use of PAİR in human cystic echinococcosis. Acta Trop 1997;64:94-107.
5. Sayek I, Onat D. Diagnosis and treatment of uncomplicated hydatid cyst of the liver. World J Surg 2001;25:21-7.
6. Derici H, Tansug T, Reyhan E, et al. Acute intraperitoneal rupture of hidatid cyst. World J Surg 2006;30:1879-83.
7. Ray S, Das K. Spontaneous intraperitoneal rupture of hepatic hydatid cyst with biliary peritonitis: a case report. Cases Journal 2009;2:6511.
8. Placer C, Martin R, Sanchez E, et al. Rupture of abdominal hydatid cyst. Br J Surg 1998;75:157-161.
9. Gunay K, Taviloğlu K, Berber E, et al. Travmatic rupture of hydatid cysts: a 12-year experience from an endemic region. J Travma 1999;46:164-7.
10. Kurt N, Oncel M, Gülmez S, et al. Spontaneous and traumatic intra-peritoneal perforations of hepatic hydatid cysts: a case series J Gastrointest Surg 2003;7:635-41.
11. Sözüer EM, Ok E, Arslan. M The perforation problem in hydatid disease. Am J Trop Med Hyg 2002;66:575-7.
12. Yuksel M, Kır A, Ercan S, et al. Correlation between sizes and intracystic pressure of hydatid cysts. Eur J Cardiothorac Surg 1997;12:903-6.
13. Dirican A, Yilmaz M, Unal B, et al. Ruptured hydatid cysts into the peritoneum: a case series. Eur J Trauma Emerg Surg 2010;36:375-9.
14. Dziri C, Haouet K, Fingerhut A .Treatment of hydatid cyst of the liver:where is the evidence? World J Surg 2004; 28:731-6.
15. Beyrouti MI, Beyrouti R, Abbes I, et al. Acute rupture of hydatid cyst in the peritoneum: 17 cases. Press Med 2004;33:378-4.