Spontaneous Rupture of Hydatid Cyst of the Liver in Pediatric Age Group Four Rare Cases with Literature Review

Abstract

Introduction: Hydatid cyst of the liver is usually asymptomatic,diagnosed accidentally or when there is complications such as infection or rupture.Rupture may occur spontaneously or related to trauma. Spontaneous rupture is more seen in endemic areas like Iraq and frequently seen in children. Method: Four cases with spontaneous rupture of liver hydatid cyst were reported at Mosul Pediatric Surgical Center at AL-KHANSA A Teaching Hospital. They were diagnosed by ultrasound, chest xrays and C T Scan. They underwent surgical exploration and removal of the cysts. Post-operative medical treatment with Albendazole were used prophylactly in all of them. Results: There were three males and one female, their age ranged from 5.5 to 10 years. Their main presentations were abdominal pain, one of them had respiratory symptoms while the forth had allergic reactions. Ultra sound examination was the main tool of diagnosis , chest x-rays was useful in one and C T Scan was needed in two of the cases .Surgical approach to these patients were by laparotomy in three and right lower thoracotomy in one .Removal of the cyst and cleaning of the cavity with antiseptic solution . These four hydatid cysts ruptured at different sites two of them to peritoneal cavity, one to thoracic cavity and one to extra peritoneal space. Conclusion: Liver H C rupture is a serious complication, it comes in the differential diagnosis of acute abdomen in endemic area .It needs urgent management. It can rupture at any points of liver surface to peritoneal cavity. Rupture can extend to pleura, biliary passages and extra peritoneal space when there is adhesion and erosion of the ectocyst to these structures. Rupture H.C of the liver to pleura can be dealt through thoracotomy approach without opening the abdomen. Extra peritoneal rupture of liver hydatid cyst can be dealt extra peritoneally without opening the peritoneal cavity and without contaminating the peritoneal cavity.