An extremely rare presentation of hydatid cyst disease: hepatic artery pseudoaneurysm bleeding and synchronous duodenal fistula
Öz
Aims: Hydatid cyst disease is a rare cause of upper gastrointestinal bleeding. Peculiarly if it's resulted from a ruptured hepatic artery aneurysm in the hydatid cyst cavity which is fistulated into the duodenum. We here present a case of hepatic artery pseudoaneurysm due to a complicated hydatid cyst with synchronous duodenal fistula.
Case: A 45-year-old male was admitted to the emergency department with hematemesis and hematochezia. The patient had a history of a hydatid cyst of liver and a surgical procedure of lung ecinoccosis. Endoscopy revealed an unusual ulcerated lesion in the duodenum. Yellow membranes were observed in the midst and blood oozing. After unsuccessful endoscopic sclerotherapy, a Computerized Tomography (CT) was performed. CT revealed a ruptured hydatid cyst into the duodenum and bleeding from the formed hepatic artery pseudoaneurysm. Hepatic artery coil embolization was performed urgently and a percutaneous transhepatic drainage catheter was applied to maintain the bile flow. Subsequently, a 10 Fr , 10 cm plastic stent was inserted via Endoscopic Retrograde Cholangiopancreatography (ERCP). The rare complication which was observed after embolization was the hepatic abscess. Although a percutaneous catheter was inserted initially, drainage wasn’t successful. As a last option, surgical debridement was considered.
Conclusion: If a patient who presented with upper gastrointestinal bleeding with a previous history of liver hydatid cyst, cyst complications must be listed as a differential diagnosis. Besides endoscopy, contrast-enhanced CT and ЕRCP are the essential diagnostic and therapeutic approaches.
Anahtar Kelimeler
coil embolisation, duodenal fistula, echinococcosis, hepatic artery pseudoaneurism, hydatid cyst, upper gastrointestinal bleeding
Kaynakça
- 1.McManus DP, Zhang W, Li J, Bartley PB. Echinococcosis. Lancet. 2003 Oct 18;362(9392):1295-304. doi: 10.1016/S0140-6736(03)14573-4. PMID: 14575976.
- 2.Nunnari, G., Pinzone, M. R., Gruttadauria, S., Celesia, B. M., Madeddu, G., Malaguarnera, G, et al. "Hepatic echinococcosis: clinical and therapeutic aspects." World journal of gastroenterology: WJG 18.13 (2012): 1448. DOI: 10.3748/wjg.v18.i13.1448
- 3.Saidani A, Saad S, Belhadj A, Rakkeh H, Kammoun M, Chebbi F. "Surgical management of a hepatic hydatid cyst fistulized into the duodenum: A case report." International Journal of Surgery Case Reports 88 (2021): 106518. DOI:10.1016/j.ijscr.2021.106518
- 4.Beggs, Ian. "The radiology of hydatid disease." American Journal of Roentgenology 145.3 (1985): 639-648.DOI: 10.2214/ajr.145.3.639
- 5.Alexiou K, Mitsos S, Fotopoulos A, Karanikas I, Tavernaraki K, Konstantinidis F, et al. Complications of Hydatid Cysts of the Liver: Spiral Computed Tomography Findings. Gastroenterology Res. 2012;5(4):139-143. DOI:10.4021/gr460e
- 6.Ramasamy, S., Singhal, P. M., Vats, M., & Neogi, S.. "Spontaneous Hepatic Hydatid Cyst Rupture Into the Transverse Colon." Cureus 13.7 (2021).DOI 10.7759/cureus.16799
- 7.Kafadar, Mehmet Tolga. "Primary hydatid cyst of the left-sided colon presenting with lower gastrointestinal bleeding; an extremely rare location of extrahepatic hydatid disease." (2021). DOI: 10.4103/njcp.njcp_402_20
- 8.de la Fuente-Aguilar V, Beneitez-Mascaraque P, Bergua-Arroyo S, Fernández-Riesgo M, Camón-García I, Cruza-Aguilera I, et al. Hydatidosis and the duodenum: A systematic review of the literature. World J Meta-Anal 2020; 8(3): 265-274 DOI: 10.13105/wjma.v8.i3.265
- 9.MOCOROA, A. GILMAS Y. "Hepatic hydatid cyst perforated into the duodenum and hemorrhagic." Revista espanola de las enfermedades del aparato digestivo y de la nutricion 22 (1963): 118-122. PMID: 13947972
- 10.Bahreini A, Alavinejad P, Asna Ashari M. A. “A Young Man with Hemobilia Due to a Fistula between Hepatic Artery and Biliary Tract.” Middle East journal of digestive diseases vol. 12,4 (2020): 284-287. DOI:10.34172/mejdd.2020.195
