Subcutaneous rupture of hepatic hydatid cyst

Parietal complication of the hydatid disease: Comprehensive literature review

BACKGROUND

The aim of the study was to provide an overview of the medical literature on parietal complications of hydatid disease (HD).

METHODS

A literature search was conducted on PubMed, Medline, Google Scholar, and Google databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using keywords to identify articles related to parietal complications of HD in the thoracic and abdominal cavities. The following keywords were used: HD, hydatid cyst, cystic echinococcosis, alveolar echinococcosis, abdominal HD, thoracic HD, parietal complication, cutaneous fistulization, cystocutaneous fistulization, cutaneous involvement, external rupture, external fistulization, subcutaneous involvement, and subcutaneous abscess. The language of publication, journal, or country was not included as limitation criteria, and publications dated before August 1, 2016, were considered. Articles or abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management were included in the study, whereas articles with insufficient clinical and demographic data were excluded.

RESULTS

The literature review included 52 articles involving 55 patients with parietal complications of HD. Thirty-two articles were written in English, 15 in French, 2 in Spanish, 1 in Italian, 1 in German and 1 in Russian. All 55 patients (women, 30; men, 23; unknown, 2) involved in the study were aged 7 to 93 (mean ± standard deviation, 54.5 ± 20.2) years. A total of 24 patients had cysto-cutaneous fistula (Echinococcus granulosus), 12 had subcutaneous rupture, 10 had cutaneous fistula (E multilocularis), 3 had cystosubcutaneous abscess, 3 had cysto-cutaneo-bronchial fistula, 2 had cysto-cutaneo-bronchio-biliary fistula, and 1 had cutaneo-bronchial fistula. E granulosus were detected in 43 and E multilocularis in 12 patients through clinical, radiological, or histopathological examinations.

CONCLUSION

Parietal complications such as cysto-cutaneous fistulization are a rare complication of HD. Complicated HD should be considered in the differential diagnosis of patients presenting with cutaneous involvement, especially in HD endemic regions.

[Spontaneous cutaneous fistula of hydatid liver cysts]

BACKGROUND

Spontaneous cutaneous fistula of hydatid liver cysts is a rare complication. Its genesis involves anatomic factors as well as other local factors.

AIMS

An exhaustive literature review was conducted to identify the characteristics of this complication, treatment modalities and the results obtained.

PATIENTS AND METHODS

An exhaustive bibliographic search was made for all articles published in French and English relating to parietal complications of hydatid liver cyst, from which we retained only those involving cases of cutaneous cyst fistulas (communicating rupture), to which we added our own case.

RESULTS

Seventeen cases of cystocutaneous fistula have been reported. The reason for consultation was productive cutaneous fistula. Morphological investigations were highly evocative of the diagnosis. Thirteen patients were treated by surgery, two underwent percutaneous debridement, and two declined treatment.

DISCUSSION

Cutaneous fistula constitutes a rare mode of discovery of hydatid cyst. Fistulography and CT scan are extremely useful for diagnosis. Percutaneous debridement of the hydatid cyst represents a debatable alternative to surgical therapy.

Cutaneous fistula of liver echinococcal cyst previously misdiagnosed as fistulizated rib osteomyelitis

External fistulization or subcutaneous rupture of liver echinococcal cyst (EC) is found occasionally with total of 15 cases reported in the literature. We report a case of 60-year-old female previously misdiagnosed as fistulizated osteomyelitis of the 11^th rib. At computed tomography scan, non-vital EC was noted in the third liver segment. Under suspicion of external fistulization of perforated EC the patient underwent one-stage operation-pericystectomy and complete fistula excision. A retrospective analysis of the reported cases in the literature was performed with special references to classifying this rare entity. The main purpose of this report is to highlight the possibility of such a diagnosis when cutaneous fistula occurs in a same anatomic area with hydatid EC, even that cyst is proven to be calcified. We emphasize the role of a swift and radical surgical procedure including complete fistula excision to prevent secondary dissemination and post-operative complications.

[Parietal complications of hydatid cyst of the liver. Report of two cases in Tunisia]

The aim of this study is to consider the parietal complications of the hydatid cyst of the liver: the subcutaneous rupture of the cyst and spontaneous cutaneous fistula of liver hydatid cyst. 1(st) case: A 24-year-old woman, who underwent surgery 10 years ago for hydatid cyst of the liver, was admitted for a right hypochondrium mass and a fistula draining clear liquid containing cystic elements. Computed tomography (CT) showed a large cystic lesion in the subcutaneous tissue communicating with another cystic mass in the liver. The diagnosis of a cyst-cutaneous fistula due to a peritoneal hydatid cyst was established. The patient underwent surgical treatment and recovered uneventfully. 2(nd) case: A 40-year-old woman presented with a mass in her right hypochondrium. The diagnosis of subcutaneous rupture of a hydatid cyst of liver was established by ultrasonography and CT-scan. The patient underwent surgical treatment and recovered uneventfully. Parietal complications of hydatid cyst of the liver are extremely rare, clinical presentation can be derailing. The diagnosis is usually established by ultrasonography and CT-scan.

Hydatid disease presenting as cutaneous fistula: review of a rare clinical presentation

Hydatid disease has a worldwide distribution as a result of more global travel. Liver and lungs are the most common sites for the primary hydatid cysts in the human body. We managed a 68-year-old man who presented with abdominal distension and umbilical fistula, discharging daughter cysts. Ultrasound imaging of the abdomen showed hepatic hydatid cyst forming a fistula at the umbilicus. The patient underwent a laparotomy with partial cystectomy and excision of the fistula tract. The umbilicus healed after the procedure. The patient did not have any recurrences in 5 years of follow-up. Spontaneous cutaneous fistulization of liver hydatid cyst is a rare presentation. A detailed literature search revealed 15 cases published in all languages. Hydatid disease presenting as an umbilical fistula has not been reported yet. We summarize all these cases including the presentation, findings, management, and outcome. Combined surgical and medical treatment is successful in healing of hepatic hydatid cutaneous fistula.

Primary subcutaneous hydatid cysts: a review of 22 cases

AIM

We aimed to review cases of primary subcutaneous hydatid cysts whether this is a fearsome disease or a benign progressed pathology. These cysts are rare, have difficulty in diagnosis and management, particularly for inexperienced clinicians.

METHODS

We searched key words of "echinococcosis, hydatid, soft tissue, subcutaneous, cutaneous" at MEDLINE/PUBMED. We eliminated unrelated articles, cases with primary visceral hydatid focus or muscular cysts. Twenty publications including 22 patients were suitable for analysis. We contacted with authors of the articles for missing data. Follow-up periods and recurrences were updated.

RESULTS

All patients were from endemic areas and most from rural regions (90%). Most frequent locations were thigh (27%) and gluteal region (9%). Mean size was 5.7 + 3.1 cm (2-15 cm). Main symptom (70%) was painless, slow growing mass with normal overlying skin. Serologic tests were usually negative (79%). Only 45% of the patients were diagnosed as hydatid cyst before treatment. Most cases (91%) were treated by surgical excision and spillage occurred at 25% of them. Cyst pouchs were irrigated with protoscolocidal solutions after cyst removal. There was no anaphylaxis during procedures. There was no recurrence with a mean follow-up of 26 + 18 months (6-60 months).

CONCLUSION

Primary subcutaneous hydatid cyst should be in mind for differential diagnosis of soft tissue masses particularly for patients who lived in regions where hydatid cyst is endemic. There is no reported anaphylaxis or recurrence during diagnostic or therapeutic interventions. Complete excision is the best treatment option. Primary subcutaneous hydatid cysts generally look like a benign progressed disease.

Unexplainable development of a hydatid cyst

Echinococcosis is a cyclozoonosis characterized by cystic lesions usually situated inside or outside the liver. We discuss the case of a 77-year-old woman with a recurrent hydatidosis with a cyst arising from the liver, growing through the lateral right abdomen wall, and reaching the subcutaneous tissue of the lumbar region. In the literature, rare subcutaneous or muscular localizations of hydatid cysts are described, however, there is no mention of a cyst growing over the abdominal wall muscles, shaped like an hourglass, partially in the liver and partially in the subcutaneous tissue, as in our case. We have not found any pathogenetic explanation for this growth pattern which is not typical of the biological behaviour of a hydatid cyst.

Subcutaneous extension of a large diaphragmatic hydatid cyst

A 53-year-old male patient with a large hydatid cyst of the left hemidiaphragm and smaller secondary cysts located in the left thoracic cavity and upper left abdominal quadrant presented with two progressively enlarging lipoma-like masses in the left hypochondrium and under the left scapulae respectively. Total excision of all the cysts was performed through a bilateral subcostal incision, with the left hemidiaphragm near totally excised and replaced by a synthetic bilayer mesh.