An Iatrogenic Hepato-Peritoneal Hydatidosis Revealed at the Stage of Abdominal Cutaneous Fistula: A Case Report

Case Report

Austin Surg Case Rep. 2023; 8(1): 1058.

An Iatrogenic Hepato-Peritoneal Hydatidosis Revealed at the Stage of Abdominal Cutaneous Fistula: A Case Report

Othmane Bourouail*; Anwar Rahali; Elmustapha Halim; Abdelkarim Laalou; Aziz Elfadili; Njoumi Noureddine; Abderrahman Elhjouji; Aziz Zentar; Abdelmounaim Aitali

Visceral Surgery Service II, Military Teaching Hospital Mohamed V, Ibn Sina University Hospital Centre, Rabat, Morocco

*Corresponding author: Othmane Bourouail Resident of General Surgery, Visceral Surgery Department, Military Hospital of Instruction Mohammed V, Rabat, Morocco. Tel: +2120666784726 Email: Th.bourouail@gmail.com

Received: July 03, 2023 Accepted: August 05, 2023 Published: August 15, 2023

Abstract

Hydatidosis is a parasitic disease caused by the development of the larval form of Echinococcus granulosus, it is a significant public health problem in Morocco due to its frequency and the severity of some of its complications. Hepato-peritoneal hydatidosis is a rare serious condition, with a high risk of recurrence and significant morbidity and mortality. The peritoneal localization is most frequently iatrogenic caused by a previous hydatidosis surgery; the revelation by external abdomino-parietal fistulization makes it more uncommon. The large laparotomy surgery excision is the chosen treatment. Furthermore, to prevent possible recurrence a long-term antiparasitic therapy should be implemented.

In our case, it was an intra-abdominal hydatid contamination due to the iatrogenic intraperitoneal rupture of the hepatic hydatidosis. This condition was revealed at the stage of cutaneious abdominal fistulization. The abdominal CT scan showed both positive and topographic diagnosis. our therapeutic strategy associated a large laparotomy surgery and antiparasitic medical treatment.

The secondary peritoneal hydatidosis caused by iatrogenic trauma is rare but constitute a serious problem with short free recurrence disease and a high risk of morbi-mortality. This case illustrates the potential complication of hydatid cyst surgery, and the latency of the peritoneal localization.

Keywords: Hepato-peritoneal; Iatrogenic hydatidosis; Abdomino-cutaneous fistula; Surgery; Antiparasitic.

Introduction

Hydatidosis is a parasitic disease caused by the development of the cestode Echinococcus Granulosus (EG) larva especially in the liver or lungs. The food’s ingestion contaminated by the excrement of a carrier animal or the contact with infected animals are the most common modes of transmission [1]. The diagnosis is based on epidemiological, clinical, radiological, and biological characteristics [2]. The diagnosis generally made at stage of complication, in which the cyst rupture is the main complication and affects 15 to 40% of hepatic Hydatid Cysts (HC) [1,2]. This opening can occur in the bile ducts (40 to 60%) as well as in other abdominal or thoracic organs [3]. The HC rupture on the peritoneal cavity is uncommon (2-7%), mostly caused by a previous surgical intervention of the hydatidosis [1-3]. This condition constitutes a pejorative turning of the disease, immediately by the risk of anaphylactic choc and secondary, by the intraperitoneal dissemination. In this case, we report an iatrogenic hepato-peritoneal hydatidosis (HPH), widely disseminated and revealed at the stage of the Abdomino-Cutaneous Fistula (ACF).

Materials and Methods

A 62-year-old male patient presented with a cutaneous fistula in the abdomen. The patient had a history of surgical intervention for liver hydatid cyst 8 years prior with protruding dome resection.

Upon physical examination, the patient had an abdominal fistula that was discharging a clear fluid. His vital signs were stable, and there were no signs of systemic infection.

Imaging examinations were conducted, including an abdominal ultrasound and Computed Tomography (CT) scan. The ultrasound revealed the presence of a large hepatic mass with multiple cysts, while the CT scan confirmed the hepatic HCs and revealed multiple peritoneal cysts (Figure 1). The laboratory investigations showed elevated levels of eosinophils and IgG antibodies to Echinococcus granulosus.