Hydatid cyst of the liver fistulized into the inferior vena cava

Imen Ben Ismail; Marwen Sghaier; Khalil Boujmil; Saber Rebii; Ayoub Zoghlami

doi:10.1016/j.ijscr.2022.107060

Hydatid cyst of the liver fistulized into the inferior vena cava

Int J Surg Case Rep. 2022 May:94:107060. doi: 10.1016/j.ijscr.2022.107060. Epub 2022 Apr 9.

Authors

Imen Ben Ismail¹, Marwen Sghaier², Khalil Boujmil³, Saber Rebii², Ayoub Zoghlami²

Affiliations

¹ University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia. Electronic address: imen_bi@yahoo.fr.
² University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia.
³ University of Tunis El Manar, Department of Cardiac and Thoracic Surgery, The Military Hospital of Tunis, Tunisia.

Abstract

Introduction: Fistulization or rupture of hydatid liver cysts to the inferior vena cava (IVC) is an extremely rare and life-threatening condition.

Presentation of case: We report the case of a 70-year-old patient who presented with right-upper-quadrant pain and fullness evolving for 03 months. Physical examination showed dilated veins over the anterior abdominal wall and the flanks associated with lower-extremity swelling. Computed tomograph of the abdomen showed a hydatid cyst invading segments VI and VII of the liver fistulized into the inferior vena cava. The IVC was partially trombosed. The diagnosis of a possibly ruptured hydatid cyst in the inferior vena cava was then made. The patient underwent surgical management. Per-operatively the cystic cavity had bloody content but the cysto-vascular communication was not identified. Partial cystectomy was performed leaving a fairly extensive contact between the calcified pericyst and the IVC. The postoperative course was uneventful.

Discussion: Rupture of the hepatic hydatid cyst into the IVC is very rare and may lead to fatal pulmonary embolism secondary to the migration of vesicles in the pulmonary artery or haemorrhagic shock. CT scan remains the best investigation method to assess the vascular links of the hepatic hydatid cyst especially with the IVC. Surgical treatment of the hepatic hydatid cyst ruptured into the IVC mandates vascular control before the hydatid cyst is punctured or removed.

Conclusion: Fistulized hydatid cysts into the IVC should be operated on in centres equipped for extracorporeal bypass techniques, and experienced in the surgery of hepatic echinococcosis.

Keywords: Echinococcus; Hydatid cyst; Inferior vena cava; Pulmonary embolism; Ruptured hydatid cyst.