A 62 year old Tunisian male was hospitalized for exploration of abdominal distension in the preceding two months with progressive aggravation. The patient had no history of trauma, surgery or systemic disease earlier. The patient had no history of trauma, prior surgery or systemic disease. Physical examination found ascites without any other abnormality. The ascitic fluid was thick and yellow with high level of lipids. Because the ascites was so massive and chylous, without any sign of hepatic, cardiac or nephrological disorder, tuberculosis or neoplasic causes were suspected. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity with associated with many intraperitoneal cysts with a scalloping on the liver (Figure ). It showed also a heterogeneous cystic lesion in the segment II of the liver measuring 3.5 × 2.5 cm. The biliary ducts have a normal calibre. Abdominal computed tomography (CT) before and after intravenous administration of contrast agent revealed in addition a fat infiltration and a thickening of the peritoneum (Figure ). Thus an intraperitoneal rupture of a hydatid cyst was suspected and an emergency laparotomy was performed. Yellow serous fluid (2000 ml) was noted, containing many daughter vesicles disseminated through the peritoneal cavity. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface (Figure ). After a partial cystectomy, the cyst pouch was irrigated with hypertonic saline (3%), and the peritoneal cavity was washed with isotonic saline for 10 to 15 minutes. After surgery, the patient was started on albendazole (10 mg/kg) for three months.
A 27-year-old woman experienced sudden onset abdominal pain at another medical center. She was diagnosed with a ruptured hydatid cyst and was referred to our medical center. She had hypotension during her first evaluation at the emergency unit.