Anaphylactic and Hemorrhagic Shock during Disseminated Abdominal Hydatidosis Surgery: A Case Report

Hydatidosis is a frequent pathology which remains endemic in Morocco. Its preferred location is the liver while the peritoneal location remains rare, even more rarely the pelvic location. The treatment is mainly surgical, but this surgery can be complicated (intraoperatively) by potentially serious accidents, it can be implicated in the occurrence of severe allergic reactions which can be life-threatening, more rarely by hemorrhagic accidents, especially if the cysts keep important and close vascular contact. We report the observation of a case of disseminated peritoneal hydatidosis supra-mesocolic, sub-mesocolic, pelvic and hepatic surgery complicated first by anaphylactic shock and secondarily by hemorrhagic shock. We insist on the need for its rapid recognition in order to quickly institute an adequate and effective treatment. The prevention of this accident is based on surgical precautions to prevent leaks or accidental intraoperative ruptures of hydatid cysts.

Peritoneal hydatic cysts: a series of cases and the review of literature

Primary peritoneal hydatidosis is an extremely rare ( 2% of all intra-abdominal hydatid disease). Peritoneal hydatid disease is secondary to liver or splenic involvement following spontaneous rupture or accidental spillage during surgery. Methods: We made a retrospective study based on the analysis of the database of the I Surgery Clinic of the University Emergency Hospital „St. Spiridon ”from Iași, with peritoneal hydatid cyst, including all the data from the medical files. Between 1991 and 2021 a total of 18 patients were operated for primary (3) or secondary peritoneal cysts (15). During the same period, 1002 cases of hydatid cyst with various locations were treated in the Iasi Surgery Clinic: 805 abdominal (714 hepatic, 43 splenic, and 18 peritoneal) and 197 extra abdominal (thoracic, cervical, muscular, retroperitoneal, etc.). The incidence of hydatid diseases has decreased over time from 35 cases per year to 18 cases per year. In the year of the COVID pandemic (2020) the incidence decreased to 10 cases per year.Most of the patients with peritoneal hydatidosis were asymptomatic or had atypical symptoms. The diagnosis was based on the preoperative history, rupture of the cysts, serology, ultrasound and computer tomography. Open surgery was the procedure of choice (16 cases) with conservative (13 cysts) and radical (3 cysts) methods. The laparoscopic approach was performed in 2 cases of primary peritoneal hydatid cysts. Results: The outcome of surgery was good without postoperative mortality or severe morbidity and the recurrence rate was 22.2%. Conclusions: Peritoneal hydatidosis is a rare disease; it is important to prevent the disease. Clinical signs and symptoms are nonspecific for a long time.We suspect this diagnosis in the case of abdominal cystic tumors especially in endemic regions. The diagnosis is made based on the history of operated hydatid disease, clinical signs, imaging and immunological tests. Total surgical excision of hydatid cysts or partial perichystectomy after evacuation of the inactivated cyst is the chosen treatment. Proper perioperative medical treatment prevents recurrence. Long-term follow-up is necessary to detect and treat any recurrence.

When a giant ovarian cyst poses a diagnostic dilemma

Ovarian cysts seldom reach sizes of greater than 10cm. But when they attain the huge size, they pose a diagnostic challenge. Many a time, these can be confused with other cystic lesions in the abdomen such as mesenteric cysts, inclusion cysts, and peritoneal hydatidosis. Thorough clinical examination with radiological and serological investigation assistance, diagnosis can be made in certain cases. Authors present a case 40 year old female who presented with a painless huge abdominal cystic mass which was initially thought of as a hydatid cyst based on the positive serological test result during the initial evaluation. She underwent laparotomy during which it was found to be a simple ovarian cyst. Excision of cyst along with left salpingoovariotomy was performed. Huge abdominal cystic swellings need thorough clinical, radiological and biochemical analysis before planning further treatment. False positive test results should be kept in mind before proceeding before planning any intervention.