A rare emergency intraperitoneal perforation of liver hydatid cysts; Clinical presentation and surgical outcomes of double center experience. KARACİĞER HİDATİK KİSTLERİNİN KARIN İÇİNE PERFORASYONU; İKİ MERKEZİN KLİNİK VE CERRAHİ DENEYİM SONUÇLARI.

Hydatid cyst rupture should be included in the differential diagnosis of acute abdomen in endemic areas. Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. Rupture of a hydatid cyst requires emergency surgical intervention. Hydatidosis is endemic in the Mediterranean region including Morrocco, the middle and far East, Australia, New Zealand, and South America. The annual incidence of hydatid disease has been reported as 18 to 20 cases per 100000 inhabitants. Patient's age and sex, initial complaints, physical findings, size and location of the cyst, Indirect Hemagglutination Test (IHAT), laboratory data, imaging modalities, surgical procedures, reasons for perforation, the presence of anaphylaxis, complications, the presence of bile ducts on the inner surface of cystic cavity, morbidity, and mortality were evaluated. All of the patients had signs of peritoneal irritation such as tenderness and rebound. Surgical procedures include partial cystectomy (PC), omentoplasty and drainage, cystotomy and drainage, PC and capitonnage, cystotomy, drainage and capitonnage, cystectomy, cystotomy and drainage, cystotomy, drainage and right nephyrectomy, cystotomy, PC and drainage, PC and drainage and cholecystectomy and choledochoduodenostomy, cystectomy and cystotomy and drainage and cholecystectomy and  cystectomy and cholecystectomy. Median hospital stay was 13 days and median follow-up was 12 months. The reported frequency of liver hydatid cyst rupture into the peritoneal cavity ranges from 1% to 16%.  A rupture of a hydatid cyst into the abdominal cavity is a rare complication of the hydatid disease and causes serious problems and severe, life-threatening complications, including anaphylaxis. Rupture may result from trauma or may occur spontaneously from increased pressure of the cystic fluid. The main risk factors predisposing to rupture include young age, cyst diameter >10 cm, and superficial cyst location. The goal of the surgical treatment is to prevent complications, to eliminate local disease, and to minimize morbidity, mortality, and recurrence rates. OZET Kist hidatik rupturu endemik alanlarda akut karin ayirici tanisinda mutlaka akilda tutulmalidir. Abdominal kaviteye ruptur nadir ancak ciddi bir komplikasyondur ve acil cerrahi mudahale gerektirir. Kist hidatik; Akdeniz kiyilarinda, Fas, orta ve uzak doguda, Avustralya, Yeni Zelanda ve Guney Amerika'da endemik olarak gorulmektedir. Yillik insidansi 18-20/100000 olgu olarak raporlanmaktadir. Hastalarin yas ve cinsiyeti, baslangic sikayetleri, fizik muayene bulgulari, kistlerin cap ve yerlesim yerleri, indirekt hemaglutinasyon testi (IHAT) sonuclari, laboratuar bulgulari, goruntuleme yontemleri, cerrahi prosedurler, perforasyon sebepleri, anafilaksi varligi, komplikasyonlar, kist kavitesine acilan safra yolu varligi, morbidite ve mortalite degerlendirildi. Tum hastalarda rebound ve hassasiyet gibi periton irritasyon bulgulari mevcuttu. Cerrahi prosedur olarak; parsiyel kistektomi + omentoplasti + drenaj, kistotomi + drenaj, parsiyel kistektomi + kapitonaj, kistotomi + drenaj + kapitonaj, kistektomi + kistotomi + drenaj, kistotomi + drenaj + sag nefrektomi, kistotomi + parsiyel kistektomi + drenaj, parsiyel kistektomi + drenaj + kolesistektomi + koledokoduodenostomi, kistektomi + kolesistektomi + drenaj, kistotomi + drenaj + kolesistektomi ve kistektomi + kolesistektomi uygulandi. Ortalama hastanede kalis suresi 13gun ve ortalam takip suresi 12 ay’dir. Karin icine rupture olmus kist hidatik insidansi 1%-16% olarak bildirilmistir. Karin icine ruptur nadir bir komplikasyondur ve ciddi problemlere ve anafilaksi gibi hayati tehdit edici komplikasyonlara yol acar. Ruptur, travmaya ya da kist ici basincin artisina bagli spontan olabilir. Rupture zemin hazirlayan ana risk faktorleri; genc yas, kist capinin > 10cm olmasi ve kistin yuzeyel yerlesimli olmasidir. Cerrahi tedavideki ana amac; komplikasyonlari onlemek, lokal hastaligi ortadan kaldirmak ve mortalite, morbidite ve nuks oranlarini en aza indirmektir.