A 17-year-old man referred to the emergency department after falling from motorcycle. He also complained from abdominal pain and vomiting. He was admitted just 30 minutes following the accident. His blood pressure was 100/60 mmHg, heart rate of 80 per minute, respiratory rate 23 breath per minute and axillary temperature of 37.2 ºC, and oxygen saturation of 96% on room air. On physical examination (PE) only right upper abdominal pain and rebound tenderness were observed. PE on other organs did not reveal any positive findings. Chest and abdominal X-ray were normal. Initial blood investigation showed leukocytosis (15700/mm3) and other indexes were normal. Twenty minutes after admission, a diffuse urticarial rash on the whole body, mainly on his face and trunk, and generalized tenderness were noted.\nThe patient received oxygen, intravenous fluid (Ringer and Dexter an -saline serum) in addition to intravenous steroids (Hydrocortisone 200mg) and antihistamines (Chlorpheniramine 20mg) as the supportive treatment.\nFocused abdominal sonography for trauma (FAST) of his abdomen demonstrated on the presence of free fluid noted in all abdominal quadrants, especially in the morison pouch (). Also by using ultrasonography a large hyperechogenic area with local cystic (40 mm diameter) in the right lobe of the liver was showed. Based on the above information a diagnostic laparotomy was performed. Laparotomy revealed a ruptured cystic mass within the right lobe of the liver and yellow fluid containing daughter cysts and liver laceration. The cyst was removed by an open right partial hepatectomy, the peritoneal cavity washed out with hypertonic saline, and a tube drain placed in right the sub-hepatic space. He was managed in intensive care unit (ICU) and received oral Albendazole 15mg/kg/day. The drain was detached on the 7th day after operation. He was discharged ten days post-operation with a prescription of Albendazole tablet 15mg/kg/day in divided dose for six months. He was followed up on 6th and 12th months post operation. He was kept well and control trans-abdominal ultrasonography demonstrated no recurrences of the disease.
A 37-year-old man presented in our emergency unit with severe abdominal pain and anaphylactic shock signs/symptoms, such as hypotension and allergic reaction.