Radiological investigations are nonspecific and may

Radiological investigations are nonspecific and may mimic various other benign or malignant conditions. Numerous other diseases show lesions of a variable density with a peripheral enhancement on abdominal CT scans. Areas of focal calcification and liquefactive necrosis, indicating simultaneously existing different pathological stages, are observed on CT scans in hepatic TB. However, they are also observed in liver abscesses. Therefore, tissue histology is the most reliable method for correct diagnosis. The samples for tissue histology are most effectively obtained with laparoscopic-assisted liver biopsy for reducing the risk of parietal tumor seeding when a lesion is in fact a malignancy. Other features suggesting malignancy may also be explored during the procedure. A frozen section of a hepatic lesion can help health care providers decide the appropriate next step in the management of the disease. Although percutaneous biopsy is a viable option, seeding along the needle track is a small but serious concern. A poor yield of representative tissue is another disadvantage. Diaz et al reported that, using guided percutaneous needle biopsy, only 2 of 21 cases of local hepatic TB were correctly diagnosed.
Introduction Hydatid disease is a zoonosis caused by the larval form of Echinococcus granulosus. Humans become intermediate hosts of the parasite after accidental ingestion of its eggs. When these eggs penetrate the intestinal wall, most of them migrate into the liver (75%) and lungs (24%), while peritoneal involvement is much less frequent. Rupture of a hydatid cyst into the peritoneal cavity is a potentially life-threatening incident. Numerous cases and retrospective studies on ruptured hepatic hydatid cysts have been published, whereas few cases of a ruptured peritoneal hydatid cyst (PHC) have been reported.
Case Report White blood cell count, jak stat pathway level, hematocrit, and parameters of clinical blood serum chemistry, hepatic tests, and renal function tests were normal. Plain radiographs of the abdomen and chest showed an elevated right hemidiaphragm (Fig. 1). Abdominal ultrasonography (US) and computed tomography (CT) demonstrated an anechoic homogeneous unilocular cyst of 121 mm × 129 mm with well-defined borders. The lesion was located in segments IV, V, VII, and VIII of the liver with no peripheral contrast enhancement or calcifications (Fig. 2). In addition, a large intraperitoneal cyst of 139 mm × 88 mm with some daughter vesicles inside was shown. This cyst seemed to be ruptured in its lower pole into the Douglas space (Fig. 3). Furthermore, a small amount of free fluid in the abdominal cavity and a right ovarian cyst of 29 mm in diameter were observed. US/CT imaging revealed a hydatid cyst of the liver staged CE1 and a ruptured pelvic hydatid cyst staged CE2. Our patient first received appropriate measures, namely high-flow oxygen therapy, cardiac monitoring, saline solution, and intramuscular medications (epinephrine 0.5 mg and ranitidine 50 mg), to prevent anaphylactic shock. Once hemodynamic and respiratory parameters normalized 15 minutes after the initial management, the patient underwent emergency surgery for an acute abdomen caused by a likely rupture of a PHC. Her abdomen was opened using a large midline incision and 150 mL of clear peritoneal fluid was sucked out. A huge pelvic hydatid cyst fissured in its inferior wall was found. From this cyst, a large parasite and multiple daughter vesicles were extracted (Fig. 4). The cyst adhered to the small intestine, mesentery root, uterus, urinary bladder, and posterior parietal peritoneum. The peritoneal cavity was washed with hydrogen peroxide and partial cystectomy was conducted (Fig. 5). A large unruptured hydatid cyst on the right hepatic lobe was observed with the rest of the liver in an intact form. Puncture and aspiration of a clear fluid, injection of hydrogen peroxide, cystotomy, and extraction of a unique germinal membrane were performed. After a meticulous search, no biliocystic fistula was found and the cyst was managed by conducting an unroofing procedure. Cystectomy was conducted for the serous right ovarian cyst. At the end of the surgery, a drain was inserted in the hepatic residual cavity and another in the Douglas space.