Cutaneous fistula of liver echinococcal cyst previously misdiagnosed as fistulizated rib osteomyelitis

Abstract

External fistulization or subcutaneous rupture of liver echinococcal cyst (EC) is found occasionally with total of 15 cases reported in the literature. We report a case of 60-year-old female previously misdiagnosed as fistulizated osteomyelitis of the 11th rib. At computed tomography scan, non-vital EC was noted in the third liver segment. Under suspicion of external fistulization of perforated EC the patient underwent one-stage operation-pericystectomy and complete fistula excision. A retrospective analysis of the reported cases in the literature was performed with special references to classifying this rare entity. The main purpose of this report is to highlight the possibility of such a diagnosis when cutaneous fistula occurs in a same anatomic area with hydatid EC, even that cyst is proven to be calcified. We emphasize the role of a swift and radical surgical procedure including complete fistula excision to prevent secondary dissemination and post-operative complications.

Development of a cutaneous fistula following hepatic cystic echinococcosis

“…Communicating rupture involves the drainage of cyst material into the bronchioles and biliary tract that are incorporated into the pericyst. Direct rupture, as in our case, occurs when the endocyst and pericsyt rupture with the subsequent leakage of cyst components, leading to complications such as anaphylactic shock and secondary bacterial infections (Kjossev and Teodosiev 2013 ).…”

Cutaneous fistulization of the hydatid disease

“…The study details of the unavailable articles were obtained from 4 different articles. [ 5 , 6 , 14 , 15 ] Therefore, the current analysis included 40 patients (21 [52.5%] males and 19 [47.5%] females; ages, 7–93 years; mean ± SD, 54.0 ± 21.5 years). The age range of males was 29 to 87 years (mean ± SD, 57.5 ± 16.9 years) and that of females was 7 to 93 years (mean ± SD, 50.1 ± 25.0 years).…”

Management of a primary retroperitoneal hydatid cyst ruptured in the abdominal wall: A case report

“…The cyst content was purulent in our case. The parietal complications of the hydatid cyst are generally classified into 3 stages based on the depth of invasion of the lesions in the abdominal wall [ 10 ]. Stage 1 includes protruding hydatid lesions in the wall muscle layer.…”