Spleen autotransplantation on liver versus greater omentum for simultaneous injuries of liver and spleen: an experimental study.

Purpose: In a simulated situation of simultaneous spleen and liver trauma, we aimed to compare the outcomes of treating both injuries with spleen autotransplantation on the omentum (SAO) alongside hepatorrhaphy versus spleen autotransplantation as a patch on the liver parenchyma. Methods: A total of 24 rats were separated into two groups: the SAO and the spleen autotransplantation on the liver. They underwent a uniform and simultaneous procedure involving full-thickness injuries to the left lobe of the liver and grade 4 spleen injuries. We measured hemoglobin, white blood cell (WBC), complement (C3 and C4), and immunoglobulin G, M, and A (IgG, IgM, IgA) levels before and 4 weeks after the surgery. We utilized Technetium-99m scintigraphy to evaluate the posttransplant splenic graft functions 4 weeks after the surgery. Results: The two groups had no significant difference in the hematologic and immunologic factors before surgery. However, both procedures significantly reduced hemoglobin, C3, IgG, and IgA levels (all P<0.05). WBC counts significantly increased in the SAO group, whereas the IgM level decreased after the intervention (P<0.05). WBC was increased in the SAO group, while IgM and IgA were decreased in the SAO group. The Technetium uptake was similar between the two groups (P=0.3). Conclusions: In simultaneous spleen and liver injuries, the autotransplantation of splenic into the liver parenchyma appears to be a promising surgical approach for preserving spleen function and hepatorrhaphy at the same time instead of doing them separately.

Liver Resection Promotes (Regulates) Proinflammatory Cytokines in Patients with Hepatocellular Carcinoma.

Background: Several animal studies have shown the roles of cytokines in regulating liver regeneration following liver resection (LR), which is a type of surgery designed to remove cancerous tumors from the liver. This study investigated how the expressions and serum levels of some pro- and anti-inflammatory cytokines in patients with hepatocellular carcinoma (HCC) were changed during LR. Methods: Liver tissues from 15 patients with HCC were collected and the levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), IL-1α, IL-1 ß, IL-10, and transforming growth factor-beta1 (TGF-ß1) were assessed using real-time PCR assay at different times before and after LR. The serum values of TNF-α and IL-6 were also measured by ELISA. Results: After 60 and 90 minutes of LR, IL-6 gene expression was significantly increased (P < 0.001 - 0.05). The same trend was also observed in TNF-α expression after 90 minutes of LR (P < 0.01). No significant changes were observed in the expressions of IL-1α, IL-1ß, IL-10, and TGF-ß1 before and after LR. In addition, LR had significant effects on TNF-α and IL-6 serum levels (P < 0.05 - 0.0001). Conclusion: Our data provided further evidence to reveal that IL-6 and TNF-α cytokines are critical to improve liver regeneration.

Effective Factors on the Disappearance of Residual Cavity Following Conservative Surgery of Liver Hydatid Cysts.

BACKGROUND: Surgery is one of the treatments commonly used to treat liver hydatid cyst. Remaining of the residual cavity after conservative surgery may lead to some harmful complications. In this study, we evaluated the role of different factors affecting the disappearance of the residual cyst. MATERIALS AND METHODS: Seventy-five patients were evaluated in 2.5 years. Patients were divided into two groups based on the remaining or disappearance of the residual cavity in follow-up visits. The baseline demographic features, preoperative cysts' size, type of technique used to eliminate the residual cavity, and cavity wall characteristics were compared in the two groups. RESULTS: Residual cavity was disappeared in 46 (61%) patients after 2 years. Calcification of the wall and wall stiffness were more common in patients with the remained residual cavity (89.6% vs. 8.7% [P < 0.001] and 58.6% vs. 30.4% [P < 0.01], respectively). Demographic features, preoperative cysts' characteristics, and the procedure used during surgery were not statistically different between groups. CONCLUSIONS: Cyst wall calcification and wall stiffness had a role in predicting residual cavity disappearance. These factors can help surgeons to predict patients at higher risk of posthydatid cyst resection residual cavity.

Effect of N-acetylcysteine on liver and kidney function tests after surgical bypass in obstructive jaundice: A randomized controlled trial.

BACKGROUND: It has been shown that N-acetylcysteine may be useful in correcting postoperative hepatic and renal function in many pathological conditions. The present study aimed to examine the effect of N-acetylcysteine on liver and kidney function tests after surgical bypass in patients with obstructive jaundice. METHODS: & Materials: A total of 30 patients with obstructive jaundice who were candidates for bypass surgery were enrolled in this randomized clinical trial. In the case group, intravenous N-acetylcysteine (200 mg/kg per hour in the first 8 h, followed by 100 mg/kg per hour for another 16 h, the same dose for another 24 h) was administered postoperatively. Liver and renal function tests (serum AST, ALT, ALP, GGT, bilirubin, and creatinine) were compared between two groups, as well as duration of hospitalization and ICU stay. RESULTS: Postoperatively, decrease in mean serum AST (p = 0.01), ALT (p = 0.02), ALP (p = 0.01), GGT (p = 0.04) and bilirubin (total, p = 0.02, direct, p = 0.01) levels compared to the preoperative values was significantly more among cases compared to those in controls. Changes in serum creatinine, however, did not differ significantly between two groups (p = 0.18). Hospital and ICU stays were also not different between two study groups (p = 0.27 and p = 0.94 respectively). CONCLUSION: On the basis of our findings, intravenous N-acetylcysteine in patients with obstructive jaundice could significantly preserve liver function after bypass surgery. Effect of this medication on renal function; however, was not statistically significant. TRIAL REGISTRATION: Iranian Registry of Clinical Trial: IRCT2016041016473N7.

A Leiomyosarcoma of Inferior Vena Cava Presenting as a Liver Metastasis Mass in a Patient with History of Transitional Cell Carcinoma.

The most probable diagnosis for a newly detected mass in the cancer patients is secondary metastasis. However, the multiple primary tumors should not be off the table of diagnoses. In this study, a 70-year-old man with the history of transitional cell carcinoma (TCC) was reported who had been referred due to a newly detected mass in the hepatic segment one which adhered to the inferior vena cava (IVC). Although the most probable diagnosis according to the patient's medical history was secondary metastasis, the biopsy revealed a leiomyosarcoma (LMS) tumor. Therefore, a mass biopsy can be determinative for confirming the diagnosis and further management of cancer patients with a newly detected mass.

Withdrawn: Effect of Ursodeoxycholic Acid, Lawsonia Inermis and Achil-lea Millefolium Extracts on Hydatid Cyst Protoscolices

The article has been withdrawn on the request of the authors and the editor of the journal Infectious Disorders - Drug Targets.Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused. Bentham Science Disclaimer: It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneous-ly submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submit-ting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers, if and when the article is accepted for publication.

Effects of antecolic versus retrocolic duodenojejunostomy on delayed gastric emptying after pyloric preserving pancreaticoduodenectomy in patients with periampullary tumors.

BACKGROUND/OBJECTIVE: Delayed gastric emptying (DGE) is one of the most frequent complications after pyloric preserving pancreaticoduodenectomy (PPPD). The aim of this study is to evaluate the effect of antecolic versus retrocolic reconstruction of gastroentric anastomosis on DGE after PPPD. METHODS: 30 patients with diagnosis of operable periampullary malignancies who candidate for PPPD, randomized in two equal groups. Gastroentric reconstruction were done in two methods: antecolic and retrocolic. All data were collected by the same person who was completely blinded to the type of the procedure. Duration of the surgery, volume of bleeding and total volume of intraoperative blood product transfusion, time to nasogastric tube (NGT) removal, time to solid fluid toleration, volume of NGT secretions, need for NGT reinsertion, daily nausea after NGT extraction, fistula or leakage, gastric leakage, biliary leakage, postoperative abdominal or gastrointestinal bleeding requiring another operation, wound infection, intra-abdominal abscess, and any other systemic complications were measured and then analysed with SPSS software. RESULTS: According to the results, there was no significant differences between antecolic and retrocolic groups in terms of DGE (p = 0.75). Also, there were no significant differences between two groups in terms of duration of operation, volume of bleeding, blood product requirement, volume of NGT secretions, time to NGT removal, number of NGT re-insertion, time to tolerate solid foods, number of days of vomiting after NGT removal, total hospital stay. CONCLUSION: The route of gastroentric (antecolic and retrocolic) reconstruction has no impact on DGE after PPPD.

Albendazole and Treatment of Hydatid Cyst: Review of the Literature.

Human hydatid cyst or cystic echinococcosis is a life-threatening zoonotic disease that occurs in most countries worldwide and is recognized as a major public health problem. Following ingestion of Echinococcus granulosus eggs, hydatid cysts which are the larval stage of the worm are formed mostly in liver and lungs, and occasionally in other organs of human. The usual treatment for hydatid cyst is open surgery. One of the problems following surgery is the recurrence. In the last decades, albendazole has been used for the treatment of hydatid cyst. This drug can be used alone or jointly with surgical procedures. However, its efficacy has not been well documented. Thus, in this work, the treatment of hydatid cyst with albendazole in different investigations including case studies, clinical trials in human and experimental works in animals has been reviewed. According to the findings of this review, it can be concluded that treatment of hydatid cyst with albendazole may be associated with the prevention of recurrence and reduction of the size and death of the hydatid cysts.

Undifferentiated Pleomorphic Sarcoma of Pancreas: A Case Report and Review of the Literature for the Last Updates.

The most prevalent type of soft tissue sarcoma is undifferentiated pleomorphic sarcoma (UPS) or previously known as malignant fibrous histiocytoma. It accounts over 20% of all soft tissue sarcomas and occurs most frequently in the extremities, trunk, and retroperitoneum. However, it has been rarely observed in the digestive system. Pancreas sarcoma represents less than 1% of all pancreatic tumors, and primary UPS of the pancreas is even rarer. It exhibits high recurrence and poor prognosis. In this case, a 72-year-old woman with a UPS tumor which was located in the pancreas head and neck without adhesion to the retroperitoneum will be discussed.

Gastric Schwannoma: A Case Report and Review of the Literature for Gastric Submucosal Masses Distinction.

Schwannomas origin from Schwann cells sheath and generally are benign, slow-growing, and asymptomatic neoplasms which frequently appear in the head and neck. Although gastrointestinal schwannoma is really rare, the most affected organ in GI system is the stomach. Gastric schwannoma forms 0.2% of all gastric tumors. This neoplasm is always detected as a submucosal mass, the same as other gastrointestinal stromal tumors. Although these tumors have almost the same presentations, they are completely different at therapeutic options and prognoses. Hence, it is important to distinguish them apart and make an accurate diagnosis to optimize treatment outcomes. Herein, we report a case of 28-year-old woman with frequent vomiting and abdominal pain caused by 5 × 6 cm schwannoma in the antrum of the stomach. This is a rare case of gastric outlet obstruction due to a massive schwannoma. In addition, all other probable submucosal masses will be discussed at different aspects.

Scolicidal agents for protoscolices of Echinococcus granulosus hydatid cyst: Review of literature.

Hydatid cyst is the larval stage of dog tape worm Echinococcus granulosus. Protoscolices are parasite larvae that develop into adult worms in the final host intestine. During surgical treatment of human hydatidsosis spillage of live protoscolices is the major cause of hydatidosis recurrence. To prevent this problem scolicidal agent such as hypertonic salt are used to kill the protoscolices that may disseminate into the patient's tissues during surgery. However, they may have some unacceptable side effects. To find scolicidal agents with high efficacy, the effect of different compounds on protoscolices of hydatid cyst in vitro has been reviewed. Using PubMed, Scopus, Google Scholar, and SID databases articles about scolicidal effects of different agents on protoscolices of hydatid cyst in vitro were collected. Foeniculum vulgare after 5 min, metalonic extracts of Allium sativum and hypertonic saline after 10 min, and warm water after 2 min kill all alive protoscolices. The above agents that in minimum time and minimum concentration have 100% scolicidal activity, could be good candidates for further investigations.

The Role of Intraoperative Thyroglobuline Level of Lymph Node in the Management of Papillary Thyroid Cancer (Determination of a Cutoff Point).

BACKGROUND: Some studies have shown that a preoperative high concentration of thyroglobulin (Tg) in wash out of fine-needle aspiration cytology of cervical lymph nodes mandate therapeutic lymph node dissection. However, there is disagreement about the minimum concentration of Tg which could have diagnostic value. Hence, according to our literature review, this study is the first one which designed to do intraoperatively. Therefore, this study was conducted and aimed to determine the clinical diagnostic value of Tg lymph nodes in the diagnosis of metastatic thyroid cancer. METHODS: In a cross-sectional study, 65 patients with papillary thyroid carcinoma (PTC) who were thyroidectomy candidates were chosen and during surgery, before the removal of lymph nodes in the neck, fine-needle sampling was performed and the level of Tg in the samples, nature of the sample sent for biopsy and Tg levels in affected and unaffected lymph nodes were determined. RESULTS: The mean levels of washout Tg in malignant and nonmalignant lymph nodes were 622.1 ± 66.2 and 1.38 ± 0.43 ng/ml, respectively, and the difference between the two groups was significant (P < 0.001). The Tg cut-off point for the detection of lymph node metastases was 0.7 ng/dl, and according to it, Tg washout sensitivity was 93.8%, specificity of 92.4%, false positives 7.76%, false negatives 6.3%, positive predictive value was 92.3%, and negative predictive value was 93.8% and accuracy was 93.1%. CONCLUSION: Based on the results, Tg level of cervical lymph nodes in patients with PTC is a suitable criterion for the diagnosis of lymph node which can be determined through fine-needle biopsy. Therefore, it is suggested that in patients with suspicion of lymph nodes involvement during surgery, fine-needle biopsy and determination of the Tg level performed.

Associating liver partition and portal vein ligation for staged hepatectomy: A surgical technique for liver resections.

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel surgical technique liver resection in traditionally nonresectable primary intrahepatic tumors or colorectal liver metastases. MATERIALS AND METHODS: From June 2013 to March 2014, patients with primary tumor of liver or colorectal tumors with liver metastasis were selected to evaluate whether they met the initial criteria for ALPPS procedure. RESULTS: Nine patients enrolled in the study with primary diagnoses of colon and rectosigmoid cancer, carcinoid tumor, gastrointestinal stromal tumor of small intestine, hepatocellular carcinoma, and pancreatic neuroendocrine tumor (PNET). Four candidates excluded from the study prior or during the first step operation due to fatty liver, hepatic fibrosis, peritoneal seeding, and multiple small intestine metastases. Five patients underwent two stages of ALPPS with the interval of about 1 week. Liver hypertrophy was 100% among our candidates after the initial step. One postoperative death happened because of massive pulmonary thromboembolism Recurrence of liver metastasis was seen in one patient. Hepatic failure Class B and A were observed in two patients which did not progress during follow-up period. One patient developed an enterocutaneous fistula. DISCUSSION: We recommend to use 2 organ bags, one for wrapping right lobe and the other one for covering visceral organs and also do liver biopsy in suspicious cases of damaged liver parenchyma and laparoscopic exploration of abdomen for seeding and multiple metastases prior to laparotomy. CONCLUSION: As the procedure has not been well established and verified by oncologists yet, further studies are required to define the exact indications of ALPPS.

Comparing the efficacy of routine H&E staining and cytokeratin immunohistochemical staining in detection of micro-metastasis on serial sections of dye-mapped sentinel lymph nodes in colorectal carcinoma.

BACKGROUND: The significance of techniques used for detecting micro-metastasis (MM) or isolated tumor cells (ITCs) is a controversial issue among investigators. We evaluated the different techniques used on sentinel lymph node (SLN) to detect MM/ITCs. MATERIALS AND METHODS: Ninety-one SLNs of 15 patients underwent serial section with 100 µm interval. In each level, two sections were prepared. One section was stained with H&E and another with anti-cytokeratin antibody (immunohistochemistry). Then the sections were evaluated for detecting MM/ITCs. Results were analyzed by chi-square test. RESULTS: 1656 sections of 91 SLNs of 15 patients were evaluated by a pathologist; MM was found in 1 and ITCs in 1 case. Overall, 2 out of 15 cases (13.3% of the patients) showed MM/ITCs by IHC staining. So, serial section along with using IHC was superior than serial section and routine H&E staining. But it did not affect the 5-year survival of the patients (P = 0.47). CONCLUSION: Using the combined techniques of serial section and IHC staining could up-stage 13.3% of colon cancer patients who were lymph node negative. In other studies with different combination of serial section, IHC staining, and PCR, investigators were able to find MM/ITCs in 3-39% of the cases. In our study, although serial section and IHC staining could up-stage 13.3% of patients, it could not affect the 5-year survival of the patients.

Immunological diagnosis of human hydatid cyst using Western immunoblotting technique.

BACKGROUND: Echinococcosis is a parasitic disease with worldwide distribution which is caused by the tapeworms Echinococcus granulosus. Diagnosis of the disease relies on imaging techniques, but the techniques are not able to differentiate the cyst from benign or malignant tumors; hence, appropriate serologic methods are required for the differential diagnosis of the infection. MATERIALS AND METHODS: In this investigation, different sheep hydatid cyst antigens probed with thirty sera of patients with hydatid cyst and also thirty human normal sera using Western immunoblotting technique. Considering results of surgery as gold standard, sensitivity and specificity of Western blotting was estimated. RESULTS: Sera of 29, 26, and 16 patients with hydatid cyst reacted with specific bands of hydatid cyst fluid (HCF), protoscolex crude antigen, and cyst wall crude antigen, respectively. However, none of the normal human sera reacted with those specific bands. CONCLUSION: A 20 kDa band of sheep HCF is an appropriate antigen for serodiagnosis of hydatid cyst infection.

Distribution of mediastinal ectopic thymic tissue in patients without thymic disease.

BACKGROUND: Different approaches to treat myasthenia gravis showed variable outcomes probably because of remained ectopic thymic tissue. The aim of this study is to determine incidence of thymic tissue in cases without any thymic disease. MATERIALS AND METHODS: Seventy-two patients scheduled for open heart surgery during 2000 and 2007 without thymic disease that were enrolled in the study at Chamran Hospital. Intraoperative biopsies were taken form aortopulmonary window, aortocaval groove and left and right pericardiophrenic regions. Finally, the distribution of ectopic thymic tissue was evaluated in above regions. RESULTS: Thymic tissue was found overall in 70.85% of patients. The most common sites for thymic tissue were left pericardiophrenic (50%) and right pericardiophrenic (31.9%) regions. Frequencies of ectopic thymus in aortopulmonary window and aortocaval groove were 19.4% and 12.5%, respectively. CONCLUSION: Because of high incidence of ectopic thymic tissue in mediastinum in patients without thymic disease, we recommend wide excision of thymus gland and all of adipose tissue in patients with myasthenia gravis.

A randomized clinical trial comparing the effect of different haemostatic agents for haemostasis of the liver after hepatic resection.

Introduction. Operative blood loss is still a great obstacle to liver resection, and various topical hemostatic agents were introduced to reduce it. The aim of the current study is to evaluate effects of 3 different types of these agents. Methods. In this randomized clinical trial, 45 patients undergoing liver resection were assigned to receive TachoSil, Surgicel, and Glubran 2 for controlling bleeding. Intraoperative and postoperative findings were compared between groups. Results. Postoperative bleeding (0 versus 33.3%, P = 0.04) and drainage volume first day after surgery (281.33 ± 103.98 versus 150.00 ± 60.82 mL, P = 0.02) were significantly higher in Surgicel than in TachoSil group. Postoperative complications included bile leak (3 cases in Surgicel, 1 case in TachoSil and Glubran 2), noninfectious collection (2 cases in TachoSil and Surgicel and 1 case in Glubran 2), perihepatic abscess, and massive hematoma around hepatectomy site both in Surgicel group. There was no death during the study period. Conclusion. Due to higher complications in Surgicel group, its application as hemostatic agent after liver resection is not recommended. Better results in TachoSil in comparison to the other two are indicative of its better efficacy and superiority in controlling hemostasis.

Do patients with penetrating abdominal stab wounds require laparotomy?

BACKGROUND: The optimal management of hemodynamically stable asymptomatic patients with anterior abdominal stab wounds (AASWs) remains controversial. The goal is to identify and treat injuries in a safe cost-effective manner. Common evaluation strategies are local wound exploration (LWE), diagnostic peritoneal lavage (DPL), serial clinical assessment (SCAs) and computed tomography (CT) imaging. Making a decision about the right time to operate on a patient with a penetrating abdominal stab wound, especially those who have visceral evisceration, is a continuing challenge. OBJECTIVES: Until the year 2010, our strategy was emergency laparotomy in patients with penetrating anterior fascia and those with visceral evisceration. This survey was conducted towards evaluating the results of emergency laparotomy. So, better management can be done in patients with penetrating abdominal stab wounds. PATIENTS AND METHODS: This retrospective cross-sectional study was performed on patients with abdominal penetrating trauma who referred to Al- Zahra hospital in Isfahan, Iran from October 2000 to October 2010. It should be noted that patients with abdominal blunt trauma, patients under 14 years old, those with lateral abdomen penetrating trauma and patients who had unstable hemodynamic status were excluded from the study. Medical records of patients were reviewed and demographic and clinical data were collected for all patients including: age, sex, mechanism of trauma and the results of LWE and laparotomy. Data were analyzed with PASW v.20 software. All data were expressed as mean ± SD. The distribution of nominal variables was compared using the Chi-squared test. Also, diagnostic index for LWE were calculated. A two-sided P value less than 0.05 was considered to be statistically significant. RESULTS: During the 10 year period of the study, 1100 consecutive patients with stab wounds were admitted to Al-Zahra hospital Isfahan, Iran. In total, about 150 cases had penetrating traumas in the anterior abdomen area. Sixty-three (42%) patients were operated immediately due to shock, visceral evisceration or aspiration of blood via a nasogastric tube on admission. Organ injury was seen in 78% of patients with visceral evisceration. Among these 87 cases, 29 patients' (33.3%) anterior fascia was not penetrated in LWE. So, they were observed for several hours and discharged from the hospital without surgery. While for the remaining 58 patients (66.6%), whose LWE detected penetration of anterior abdominal fascia, laparotomy was performed which showed visceral injuries in 11 (18%) cases. CONCLUSIONS: All in all, 82 percent of laparotomies in patients with penetrated anterior abdominal fascia without visceral evisceration, who had no signs of peritoneal irritation, were negative. So, we recommended further evaluation in these patients. However, visceral evisceration is an indication for exploratory laparotomy, since in our study; the majority of patients had organ damages.

Penetrating neck trauma: review of 192 cases.

BACKGROUND: The neck region contains a high density of vital organ structures within a relatively small and unprotected anatomic region, making it one of the most vulnerable areas of the body for all types of injuries. OBJECTIVES: In this article, we studied penetrating neck trauma cases in Alzahra Hospital over a 10-year period. PATIENTS AND METHODS: In this retrospective, descriptive, analytical study, penetrating neck trauma cases admitted to Alzahra Hospital between April 2000 and April 2010 were analyzed for epidemiology, mechanism of trauma, zone of trauma, therapeutic method, injuries to other organs, complications, and mortality. RESULTS: Among 192 penetrating neck injuries, the mean age at the time of injury was 25.08 ± 15.02 years. Of these cases, 96.4% occurred in men. The most common mechanisms of trauma was stab wounds (85.93%). In 56.3% of penetrating neck injuries, zone 2 was involved. Neck exploration was positive in 84.4% of cases, and 52.1% of patients underwent surgery. Vascular exploration was the most common cause of surgery (67.2% of patients). The most common surgical intervention was vein ligation (50.8% of cases). In 11.98% of cases, another organ injury occurred simultaneously, and chest injury was the most common coexisting problem (65.2%). Complications were reported in 9.3% of patients, and the need for intubation was the most common complication (5.2% of patients). Mortality rate was 1.5%. CONCLUSIONS: According to the findings of this study, the most common cause of penetrating neck injuries was stab wounds, and the majority of patients were young men, therefore, preventive measures should be implemented. Because of fatal complications associated with neck injuries, we recommend early neck exploration in unstable cases or when injuries are deeper than the platysma.

Anaphylactic shock caused by nonruptured hydatid cyst of the liver.

Anaphylactic reaction is a known complication of cystic hydatid disease, a parasitic infestation caused by the larval/cyst stage of Echinococcus granulosus that usually happens after trauma or during interventions. Nontraumatic leakage of cyst contents into the blood circulation is an uncommon triggering factor for anaphylaxis, which is rarely reported in available literatures. We describe anaphylaxis in a 47-year-old lady who was admitted for evacuation of hydatid cyst of the liver. Unfortunately, she developed signs and symptoms of anaphylaxis in the ward while waiting for her operation. However, the condition was controlled immediately, and she was taken to the operating theater for surgery. As she had not sustained any trauma in the ward and operative exploration did not reveal any macroscopic rupture, we assumed that her problem must have been caused by nontraumatic spillage of cyst material into circulation. Although the condition is not common, one should bear in mind the possibility of such diagnosis in all patients with Eccinococcous infection who develop shock especially in areas where this infestation is endemic.