Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2019; 11(3): 318-329
Published online Mar 27, 2019. doi: 10.4254/wjh.v11.i3.318
Intraperitoneal rupture of the hydatid cyst: Four case reports and literature review
Sami Akbulut, Fatih Ozdemir
Sami Akbulut, Fatih Ozdemir, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Author contributions: Akbulut S designed the report; Akbulut S and Ozdemir F collected the clinical data; Akbulut S and Ozdemir F analyzed the data and wrote the paper.
Informed consent statement: The patients involved in this study gave informed written consent prior to study enrollment, authorizing the use and disclosure of their protected health information.
Conflict-of-interest statement: The author declares no potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sami Akbulut, MD, Associate Professor, FACS, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya 44280, Turkey.
Telephone: +90-422-3410660 Fax: +90-422-3410036
Received: November 29, 2018
Peer-review started: November 30, 2018
First decision: December 17, 2018
Revised: January 19, 2019
Accepted: January 29, 2019
Article in press: January 30, 2019
Published online: March 27, 2019

Most patients with hydatid cysts are asymptomatic, and they are diagnosed incidentally during radiological evaluations performed for other reasons. However, some patients develop symptoms and complications due to cyst size, location, and the relationship between the cyst and adjacent structures. The most serious complications that can occur are rupture of the cysts into the biliary tract, vascular structures, hollow viscus, and peritoneal cavity. We aimed to describe the management of four cases of intraperitoneal rupture of hydatid cysts.


Four patients aged between 27 and 44 years (two men and two women) were admitted to our clinic with sudden abdominal pain (n = 4), hypotension (n = 3), and anaphylaxis (n = 2). Three of the perforated cysts were located in the liver, and one was located in the spleen. Two patients developed cyst rupture after minor trauma, and the other two developed spontaneous rupture. Enzyme-linked immunosorbent assay IgG results were positive for two patients and negative for the other two. All patients received albendazole treatment after surgical intervention (range: 2-6 mo). Two patients developed hepatic abscesses requiring drainage; one of these patients also developed hydatid cyst recurrence during postoperative follow-up (range: 25-80 mo).


Intraperitoneal rupture is a life-threatening complication of hydatid cysts. It is important to manage patients with surgical intervention as soon as possible with aggressive medical treatment for anaphylactic reactions.

Keywords: Hydatid cyst, Complication, Inraperitoneal rupture, Spontaneous rupture, Traumatic rupture, Anaphylactic reactions, Case report

Core tip: Spontaneous or traumatic intraperitoneal hydatid cyst rupture is a rare but life-threatening complication. Therefore, hydatid cyst rupture should be considered as a differential diagnosis in patients who have sudden onset abdominal pain and allergic reactions like urticaria, especially those in regions endemic to the disease. Deteriorated hemodynamic parameters due to anaphylactic reactions should be corrected quickly with subsequent emergent surgery for a life-saving procedure. Herein, we aimed to present the management algorithm of four patients diagnosed with intraperitoneal hydatid cyst rupture.