BOWEL OBSTRUCTION MIMICKING HEPATIC HYDATID CYST RUPTURE. CASE REPORT
The hydatid cyst is generated by a parasite which is endemic in Eastern Europe and the Mediterranean area. Rupture of the cyst can trigger an anaphylactic reaction. Therefore, early recognition of rupture symptoms is critical. We here present the case of a patient who knew she had a hepatic hydatid cyst and had refused surgery. She presented to the emergency department for a rapid deterioration of her health status: nausea, vomiting, intense abdominal pains, and visible chills. The ultrasound image suggested a ruptured and infected hepatic hydatid cyst and slightly dilated, hyperkinetic intestinal loops. CT examination revealed bowel obstruction and hydatid cyst appearance unchanged as compared to the previous examination. Symptoms of rupture of a hepatic hydatid cyst include: intense abdominal pain, biliary tree dilation, free fluid in the abdomen, up to fever and hypotension. There are other medical conditions that may simulate rupture of a hydatid cyst. In this case, ultrasound examination revealed the possible cause of deterioration in patient’s state of health (hepatic hydatid cyst). The accelerated peristalsis was wrongly interpreted because of cyst rupture, and not a sign of incipient bowel obstruction. It was the CT examination that helped in making the correct diagnosis, bowel obstruction. However, CT scan did not reveal the cause of bowel obstruction but ruled out some possible causes (wall thickening or tumor). The cause of bowel obstruction (adhesions) was established by the correlation of CT findings with medical history and was confirmed surgically and pathologically.
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