Simultaneous primary hydatid cysts of liver and spleen with spontaneous intraperitoneal rupture of liver cyst.

Abstract

An 18-year-old male patient presented with recurrent vomiting, dull aching pain, heaviness and fullness in upper abdomen for approximately six month duration. On examination there was hepatosplenomegaly with mild tenderness and dullness on percussion. USG abdomen was suggestive of large cystic lesion in right lobe of liver and spleen. Patient underwent CECT abdomen which show large cyst of liver and spleen [Table/Fig-1]. Patient was planned for surgery and discharge on preoperative albendazole 400 mg BD with advice to follow weekly. Three days later, same patient presented to emergency department with sudden onset pain in abdomen associated with abdominal distention. On examination there was tachycardia (pulse 112/min), blood pressure was 90/60 mmHg, abdomen was tender and diffuse peritonitis was there. [Table/Fig-1]: CECT abdomen showing large cysts in liver and spleen Patient was resuscitated for anaphylactic shock and peritonitis with intravenous fluid, antibiotics, antihistaminic and steroid. After resuscitation, emergency laparotomy was performed. On exploration, a ruptured liver cyst with collection in perihepatic area was revealed. Splenic cyst was also present but it was intact. The germinal membrane was removed from hepatic cyst pouch and splenectomy was performed [Table/Fig-2]. Specimen of spleen was consisting of multiple daughter cysts [Table/Fig-3]. The peritoneal as after renumbering only three figure will remain cavity was irrigated with warm 3% hypertonic saline for 15 min followed by tube drainage of cyst cavity. Post operative period was uneventful and patient was discharge on 9th postoperative day with albendazole therapy for three months. Three months later, there was no evidence of residual disease present. [Table/Fig-2]: Hepatic cyst after removal [Table/Fig-3]: Splenic cyst showing multiple daughter cysts