Case Report: Portal cavernoma secondary to multiple liver hydatidosis: A rare cause of cataclysmic haemorrhage in a young adult.

Alia Zouaghi,Mona Cherif,Dhafer Hadded,Haithem Zaafouri,Nawel Bellil,Anis Ben Maamer,Khalaf Ben Abdallah

doi:10.12688/f1000research.74012.1

Abstract

Clinical presentation of liver hydatidosis can vary from asymptomatic forms to lethal complications. We report a rare case of a 27-year-old male from a rural Tunisian region who presented with large-abundance haematemesis, haemodynamic instability, and marked biological signs of hypersplenism. Endoscopy showed bleeding esophageal varicose veins that were ligated. Abdominal ultrasound concluded the presence of three type CE2 hydatic liver cysts causing portal cavernoma with signs of portal hypertension. Despite resuscitation, the patient died of massive rebleeding leading to haemorrhagic shock. Hepatic hydatid cyst should be considered as an indirect cause of gastrointestinal bleeding in endemic countries. Early abdominal ultrasound in varicose haemorrhage is essential in orienting the diagnosis.

Highlights

Echinococcosis liver hydatidosis is endemic in the Maghreb countries
Compression or invasion of the hydatic cyst in the portal vein can lead to portal vein thrombosis or extrahepatic portal vein obstruction (EPVHO).[2]
This can rarely lead to cavernous transformation and portal hypertension explaining the origin of symptoms

Summary

Introduction

Echinococcosis liver hydatidosis is endemic in the Maghreb countries. Vascular complications are exceedingly rare,[1] its manifestations can be critical. Abdominal examination revealed slight epigastric tenderness and splenomegaly without hepatomegaly or skin signs of hepatocellular failure. Minor signs of hepatocellular insufficiency were displayed including a low rate of prothrombin ratio of 60% and hypocholesterolemia of 2.87 mmol/L. The patient was stabilized following fluid resuscitation and blood transfusion of two red blood cell concentrates. He was put on a proton-pump inhibitor (omeprazole) and octreotide. Upper gastroduodenoscopy showed the presence of oesophageal varices with massive active bleeding, moderate hypertensive gastropathy and gastric varicose veins (Figure 1). The patient had a cataclysmic re-bleeding causing refractory hemorrhagic shock and disseminated intravenous coagulation leading to death

Discussion

Conclusion

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