Diagnosis and surgical treatment of cysto-gastric fistula out of an hepatic hydatid cyst. Unusual case.

BACKGROUND: Hydatid cyst is an endemic zoonotic infection that annual incidence ranges from <1 to 200 per 100,000 individuals. The most common complication of hepatic hydatid cyst reported is rupture of the cysts, most commonly intrabiliary rupture. Direct rupture to hollow visceral organs is rarely seen. We describe here an unusual cystogastric fistula in a patient with liver hydatid cyst. CASE PRESENTATION: The 55-year-old male patient presented with right upper quadrant abdominal pain. After radiological imaging studies, the diagnose was of hydatid cyst involving the left lateral segment of the liver ruptured into the gastric lumen and resulted in a cystogastric fistula. Gastroscopy revealed that the cyst and its contents protruding from anterior wall to the gastric lumen. Partial pericystectomy and omentopexy were performed and the gastric wall was primarily repaired. There were no complications in the postoperative period and 3-month follow up. CONCLUSION: This case, to our knowledge, is the first reported case of cystogastric fistula surgically treated in a patient with liver hydatid cyst in the literature. Our clinical experience shows that, although it is a benign disease, complicated hydatid cysts should be evaluated in detail preoperatively, and after the detailed diagnostic work-up, surgical therapy might be planned individually for each case. KEY WORDS: Cysto-gastric fistula, Hydatid Cyst, Liver hydatidosis.

Recurrent Type 1 Enterocutaneous Fistula and Granulomatous Gastritis: A Case Report.

BACKGROUND Enterocutaneous fistula is an abnormal communication between the gastrointestinal tract and skin. One-third of enterocutaneous fistulas disappear spontaneously, but the rest of them require surgical treatment. CASE REPORT We describe the case of a 34-year-old woman with enterocutaneous fistula that she had had for year. She had previously undergone 2 unsuccessful operations, and the fistula recurred twice. Distal subtotal gastrectomy and Billroth 2 reconstruction were performed. In the pathological examination, the distal gastrectomy specimen revealed foci of ulceration. Well-circumscribed non-necrotizing granulomas were occasionally encountered beneath the ulcers. CONCLUSIONS Failure of treatment in recurrent fistula management has a variety of reasons. Our clinical experience shows that granulomatous gastritis can be a complicating factor in treatment of recurrent enterocutaneous fistula.