Splenik hidatik kist cerrahisinde anafilaktik şok: Olgu sunumu

Yıl 2018, , 154 - 156, 01.05.2018

Anas Belhaj , Ouazzani Et-tayeb Karim Ibn Majdoub Imane Toughrai Said Ait Laalim Khalid Mazaz

https://doi.org/10.28982/josam.398389

Cited By: 2

Öz

Hidatik hastalık Echinococcus granulosus'un neden olduğu yaygın bir parazit enfeksiyonudur. İzole splenik tutulum endemik bölgelerde bile nadir bir durumdur. Dalak kist hidatiklerinin tedavisi çoğunlukla cerrahi yöntemdir. Anafilaktik şok gibi cerrahi sırasında komplikasyonlar görülebilir. Burada, splenik kist hidatik için hastanemize yatırılan bir olgu sunulmuştur. Hasta 31 yaşındaydı. Sol hipokondride mütevazı bir ağrı nedeniyle başvurdu. Karın muayenesinde sol hipokondri ve epigastrik bölgelerde hafif hassasiyet vardı. Hepatomegali bulunamadı. Abdominal bilgisayarlı tomografide, çapları 8 cm, çapları 2 cm olan ve yüzer membranlar içeren, izole splenik kistik lezyon izlendi. Hasta ameliyat edildi ve sol subkostal kesi yapıldı. Cerrahi incelemede, splenik parankima orta bölgesini işgal eden hidatik bir kist ortaya çıkmış, üst ve alt yüzeyde sadece ince bir tabaka splenik doku mevcuttu. Ameliyatın sonunda hasta taşikardi, hipotansiyon ve yaygın cilt eritemi oluştu. Sonuçta hemodinamik istikrarsızlık, spesifik tedaviye başlanabilmesi için anafilaksi teşhisi konmalıdır, anafilaksi şiddeti nedeniyle tüm önleyici tedbirler alınmalıdır.

Anahtar Kelimeler

Anafilaktik şok, Kist hidatik, Önleme, Cerrahi

Anaphylactic shock during splenic hydatid cyst surgery: A case report

Öz

Hydatid disease is a common parasitic infection caused by Echinococcus granulosus. Isolated splenic involvement is an uncommon condition even in endemic regions. The treatment of a splenic hydatid cyst is mainly surgical. Complications can occur during surgery such as anaphylactic shock. We report here the case of a patient who was admitted in our hospital for splenic hydatid cyst. She was 31 years old. She was admitted for a dull pain in the left hypochondrium. An abdominal examination objectified a patient with normal vital signs, she had a slight tenderness in the left hypochondria and epigastric regions. No hepatomegaly was found. Abdominal computed tomography revealed an isolated splenic cystic lesion measuring about 8, 2 cm in diameters and containing floating membranes. The patient was operated and a left subcostal incision. The Surgical exploration revealed a hydatid cyst occupying the middle region of splenic parenchyma, only a thin layer of splenic tissue was present in superior and inferior surface. At the end of the surgery the patient presented tachycardia, hypotension and extensive skin erythema. Conclusion: hemodynamic instability, should suggest the diagnosis of anaphylaxis in order to begin specific management, all preventive measures can be justified given of severity of anaphylaxis.

Anahtar Kelimeler

Anaphylactic shock, Hydatid cyst, Prevention, Surgery

Kaynakça

• 1. Amr SS, Amr ZS, Jitawi S, Annab H. Hydatidosis in Jordan: An epidemiological study of 306 cases. Ann Trop Med Parasitol. 1994;88:623–7.
• 2. Durgun V, Kapan S, Kapan M, Karabiçak I, Aydogan F, Goksoy E. Primary splenic hydatidosis. Dig Surg. 2003;20:38–41.
• 3. Rodriguez-Leal GA, Moran-Villota S, Milke-Garcia Mdel P. Splenic hydatidosis: a rare differential diagnosis in a cystic lesion of the spleen. Rev Gastroenterol Mex. 2007;72:122-5.
• 4. Malik AA, ul Bari S, Younis M, Wani KA, Rather AA. Primary splenic hydatidosis. Indian J Gastroenterol. 2011;30:175-7.
• 5. Derici H, Tansug T, Reyhan E, Bozdag AD, Nazli O. Acute intraperitoneal rupture of hydatid cysts. World J Surg. 2006;30:1879-83.
• 6. Mokhtari MAM, Spoutin A. Splenic hydatid cyst and relevation with anaphylaxis. Research Journal of Medical Sciences. 2008;2:248-50.
• 7. Wani RA, Malik AA, Chowdri NA, Wani KA, Naqash SH. Primary extrahepatic abdominal hydatidosis. Int J Surg. 2005;3:125-7.
• 8. Ormeci N, Soykan I, Palabiyikoğlu M, et al. A new therapeutic approach for treatment of hydatid cysts of the spleen. Dig Dis Sci. 2002;47:2037-44.
• 9. Limas C, Soultanidis C, Kirmanidis MA, et al. Management of abdomen hydatidosis after rupture of a hydatid splenic cyst: a case report. Cases J. 2009;2:8416.
• 10. Culafic DM, Kerkez MD, Mijac DD, et al. Spleen cystic echinococcosis: clinical manifestations and treatment. Scand J Gastroenterol. 2010;45:186-90.
• 11. Take Z, Yagci AB, Attala AO, et al. splenic hydatid cyst perforating into the colon manifesting as acute massive lower gastrointestinal bleeding: an unusual presentation of disseminated abdominal echinococcosis. Singapore Med J. 2008;49:e113-6.
• 12. Boyano T, Moldenhauer F, Mira J, Joral A, Saiz F. Systemic anaphylaxis due to hepatic hydatid disease. J Investig Allergol Clin Immunol. 1994;4:158–9.
• 13. Shameem M, Akhtar J, Bhargava R, Ahmed Z, Khan NA, Baneen U. Ruptured pulmonary hydatid cyst with anaphylactic shock and pneumothorax. Respir Care. 2011;56:863–5.
• 14. Tonnelet R, Jausset F, Tissier S, Laurent V. Spontaneous rupture of a hydatid cyst and anaphylactic shock] J Radiol. 2011;92:735–8.
• 15. Vuitton DA. Echinococcosis and allergy. Clin Rev Allergy Immunol. 2004;26:93–104.
• 16. Jakubowski MS, Barnard DE. Anaphylactic shock during operation for hydatid disease. Anesthesiology. 1971;34:197–9.
• 17. Khoury G, Khoury SJ, Soueidi A, Nabbout G, Baraka A. Shock complicating laparoscopic treatment of hydatid cysts of the liver. Surg Endosc. 1998;12:452–4.
• 18. Perricone R, Fontana L, De Coralis C, Ottaviani P. Activation of alternative complement pathway by fluid from hydatid cysts. N Engl J Med. 1980;302:808–9.
• 19. Kosar A, Orki A, Haciibrahimoglu G, Kiral H, Arman B. Effect of capitonnage and cystotomy on outcome of childhood pulmonary hydatid cysts. J Thorac Cardiovasc Surg. 2006;132:560–4.
• 20. Santini M, Fiorello A, Vicidomini G, Perrone A. A home-made device for safe intraoperative aspiration of pulmonary hydatid cysts. Interact Cardiovasc Thorac Surg. 2008;7:365–7.
• 21. Neumayr A, Troia G, de Bernardis C, Tamarozzi F, Goblirsch S, Piccoli L, et al. Justified concern or exaggerated fear: The risk of anaphylaxis in percutaneous treatment of cystic echinococcosis: A systematic literature review. PLoS Negl Trop Dis. 2011; 5:e1154.
• 22. Kambam JR, Dymond R, Krestow M, Handte RE. Efficacy of histamine H1 and H2 receptor blockers in the anesthetic management during operation for hydatid cysts of liver and lungs. South Med J. 1988;81:1013.