Acute peritonitis secondary to spontaneous rupture of hepatic hydatid cyst: A case report and literature review

Abstract

Spontaneous intraperitoneal rupture of hepatic hydatid cysts is a rare but serious complication that can lead to significant morbidity and mortality due to risks such as anaphylactic shock and secondary peritoneal hydatidosis. This report presents the case of a 59-year-old male farmer from a rural area of Tunisia who presented with severe abdominal pain, nausea, and vomiting. Diagnostic imaging revealed a large hepatic cyst with free peritoneal fluid, indicating a ruptured hydatid cyst. Emergency surgery involved cyst evacuation, peritoneal lavage, and drainage. Postoperatively, the patient developed a transient biliary fistula but recovered well with albendazole therapy to prevent recurrence. Six months post-surgery, the patient remains asymptomatic. The case underscores the importance of considering hydatid disease in acute abdomen diagnoses in endemic regions and highlights the critical role of imaging and timely surgical intervention. The literature review indicates variability in the prevalence of cyst rupture and emphasizes the need for a comprehensive approach combining surgery and antiparasitic treatment for effective management and recurrence prevention. • Acute peritonitis from intraperitoneal rupture of hepatic hydatid cyst is a rare occurrence. • Sudden severe abdominal pain and rebound tenderness suggest a ruptured hydatid cyst. • CT scan confirms diagnosis with a 12 cm cyst and peritoneal fluid in the abdomen. • Emergency surgery and albendazole therapy prevent recurrence and manage condition. • Early recognition of hydatid cyst rupture is crucial in endemic Mediterranean regions.