Hydatid Disease of the Liver Presenting as Spontaneous Cutaneous Fistula: A case report.

Hydatid cyst (HC) disease is a parasitic infection produced by cysts containing the Echinococcus granulosus larval phase. Patients with HC disease are typically asymptomatic until incidentally diagnosed or when complications occur. A rare presentation of liver HC is spontaneous cutaneous fistualisation. We report a 63-year-old female patient admitted in a tertiary care hospital in Ibb, Yemen, in 2019 with an infected cutaneous fistula induced by a ruptured HC. The patient underwent laparotomy and partial cystectomy with excision of the fistula tract. Upon 6-month follow-up, there was no HC recurrence. This report highlights the need for physicians to consider this diagnosis when faced with an unusual cutaneous fistula near organs commonly involved in HC, especially in areas where the prevalence of this disease is high.

Cutaneous fistulization of the hydatid disease: A PRISMA-compliant systematic review.

AIM: To provide an overview of the medical literature on cutaneous fistulization in patients with hydatid disease (HD). METHODS: According to PRISMA guidelines a literature search was made in PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to cutaneous fistulization of the HD. Keywords used were hydatid disease, hydatid cyst, cutaneous fistulization, cysto-cutaneous fistulization, external rupture, and external fistulization. The literature search included case reports, review articles, original articles, and meeting presentations published until July 2016 without restrictions on language, journal, or country. Articles and abstracts containing adequate information, such as age, sex, cyst size, cyst location, clinical presentation, fistula opening location, and management, were included in the study, whereas articles with insufficient clinical and demographic data were excluded. We also present a new case of cysto-cutaneous fistulization of a liver hydatid cyst. RESULTS: The literature review included 38 articles (32 full text, 2 abstracts, and 4 unavailable) on cutaneous fistulization in patients with HD. Among the 38 articles included in the study, 22 were written in English, 13 in French, 1 in German, 1 in Italian, and 1 in Spanish. Forty patients (21 males and 19 females; mean age ±â€Šstandard deviation, 54.0 ±â€Š21.5 years; range, 7-93 years) were involved in the study. Twenty-four patients had cysto-cutaneous fistulization (Echinococcus granulosus); 10 had cutaneous fistulization (E multilocularis), 3 had cysto-cutaneo-bronchio-biliary fistulization, 2 had cysto-cutaneo-bronchial fistulization; and 1 had cutaneo-bronchial fistulization (E multilocularis). Twenty-nine patients were diagnosed with E granulosis and 11 had E multilocularis detected by clinical, radiological, and/or histopathological examinations. CONCLUSION: Cutaneous fistulization is a rare complication of HD. Complicated HD should be considered in the differential diagnosis of cases presenting with cutaneous fistulization, particularly in regions where HD is endemic.

Spontaneous external fistula: the rarest presentation of hydatid cyst.

A 65-year-old man with hydatid disease of the liver presented with a spontaneous cutaneous rupture draining about 10 L of fluid with daughter cysts. Contrast-enhanced CT showed multiple hypodense areas in the residual right lobe of the liver and abdominal wall with compensatory hypertrophy of the left lobe, confirming the diagnosis of a hydatid cyst presenting as external fistulisation which represents a very advanced stage of hydatid disease. Once the patient's nutritional status improved he was taken for surgery. On laparotomy there were multiple cysts seen in the residual right lobe of the liver and inflammatory changes in the abdominal wall with an external fistulous opening. Right-lobe hepatectomy was carried out along with excision of the fistulous tract. The specimen showed multiple degenerated contents of the cyst with numerous daughter cysts along the fistulous tract and examination of cyst fluid demonstrated protoscolices. The postoperative period was uneventful. He was regularly followed and was doing well.

Hydatid disease presenting as cutaneous fistula: review of a rare clinical presentation.

Hydatid disease has a worldwide distribution as a result of more global travel. Liver and lungs are the most common sites for the primary hydatid cysts in the human body. We managed a 68-year-old man who presented with abdominal distension and umbilical fistula, discharging daughter cysts. Ultrasound imaging of the abdomen showed hepatic hydatid cyst forming a fistula at the umbilicus. The patient underwent a laparotomy with partial cystectomy and excision of the fistula tract. The umbilicus healed after the procedure. The patient did not have any recurrences in 5 years of follow-up. Spontaneous cutaneous fistulization of liver hydatid cyst is a rare presentation. A detailed literature search revealed 15 cases published in all languages. Hydatid disease presenting as an umbilical fistula has not been reported yet. We summarize all these cases including the presentation, findings, management, and outcome. Combined surgical and medical treatment is successful in healing of hepatic hydatid cutaneous fistula.

Spontaneous external fistula of a hydatid liver cyst in a diabetic patient.

BACKGROUND: The liver is the most common site of hydatid disease. Complications like cyst rupture and infection may occur, sites of rupture including: bile ducts, gastrointestinal tract, bronchi, peritoneal and pleural cavity. Rupture into the subcutaneous tissue followed by external fistula is an extremely rare complication. CASE REPORT: A 71-year-old diabetic woman was referred for a progressive growing mass in the right hypochondrium, with a central fistula draining clear liquid with cystic elements and white membranes. No history of fever or jaundice was present. Abdominal ultrasound (followed by CT scan) revealed a liver hydatid cyst in the right lobe, in contact with the anterior abdominal wall, and a parietal fistula track. Cystic fluid exam showed protoscolices and serological ELISA test was positive for hydatid disease. At surgery, the lesion was approached through an incision starting from the fistula site. Partial cystectomy and external drainage of the residual cavity were performed. The fistula track was totally resected. After an uneventful recovery and six months of anti - parasitic treatment, the patient is symptoms- free (3 years after surgery). CONCLUSIONS: Spontaneous cyst-cutaneous fistula is an extremely rare complication of hydatid liver cyst, usually occurring silently, in elder people. Surgery is required to achieve complete evacuation of the cyst contents and resolution of the residual cavity. To the best of our knowledge, this is the seventh case published, and the first one in the Romanian literature.

[Primary extensive hydatidosis of the thigh: unusual radiological aspects]. / Hydatidose primitive et étendue de la cuisse: aspect radiologique inhabituel.

Soft tissue involvement by hydatid disease remains unusual (5%) even in endemic areas. Patients typically present late because disease progression is slow and often asymptomatic. The authors report the unusual imaging appearance in a 59 year old woman with a one year history of progressive diffuse painless swelling of the left thigh. Ultrasonography showed multiple anechoic and hypoechoic cystic lesions, some of which containing serpentine echogenic structures consistent with partly calcified membranes. CT and MRI confirmed a diagnosis of hydatid disease and were helpful to demonstrate the relationship between cysts and adjacent structures. Surgical management was performed early because of fistulization to the skin.

Myiasis of a perineal fistula.

We report a case of myiasis of a rectocutaneous fistula in a subject suffering from bone metastases after surgical resection of a neoplastic bladder. The fistula was infested by maggots identified as third-instar larvae of flies belonging to the family Sarcophagidae, genus Sarcophaga. The infestation was neither intestinal nor pseudointestinal; it was probably caused by a fly ovipositing on the fistula of the patient while having wound care at home, even though the possibility that the infestation might have occurred during hospitalization cannot be ruled out.

Postoperative alveolar hydatid disease with cutaneous-subcutaneous involvement.

The first Japanese case of alveolar hydatid disease with cutaneous-subcutaneous lesions is reported. The patient, a 58-year-old man who developed an indurated subcutaneous tumor on the right side of the abdomen, had had partial hepatectomy of the right lobe for echinococcosis thirteen years earlier. Clinically, the tumor was adherent with a fistulosis communication to deeper structures. Histopathologically, multiple PAS-positive cuticular layers with foreign body granulomas and fibrosis were observed between the dermis and subcutaneous fatty tissue. Surgical excision of the swelling provided the patient with temporary relief. To our knowledge, only eight cases of subcutaneous alveolar hydatid disease have been reported throughout the world. Ours, the ninth case, highlights the importance and difficulty of treating of alveolar hydatid disease.

Cytologic diagnosis of Enterobius vermicularis eggs in an enterocutaneous fistula.

A middle-aged female underwent a laparotomy for suspected ovarian cancer and developed a discharging sinus in the right iliac fossa. Smears of the discharge showed helminthic eggs which were characterised as those of Enterobius Vermicularis. The possibility of an enterocutaneous fistula was suggested which was subsequently confirmed during a relook laparotomy.