Traumatic rupture of a hepatic hydatid cyst in a polytrauma patient: a case report highlighting diagnostic and management challenges.

Introduction and importance: Traumatic rupture of hepatic hydatid cysts is a rare but life-threatening complication of echinococcal disease. Rupture following blunt abdominal trauma can lead to anaphylaxis, massive peritoneal contamination, and rapid hemodynamic deterioration. Early recognition is essential, especially in endemic regions. Case presentation: A 19-year-old, previously healthy male sustained polytrauma in a high-speed motor vehicle accident. Initial assessment showed a Glasgow Coma Scale of 3 and a fixed left pupil. Computed tomography demonstrated a left subdural hemorrhage and bilateral subarachnoid hemorrhages (Fig. 1A), a traumatic rupture of a hepatic hydatid cyst with peritoneal spillage (Fig. 1B), a suspected jejunal injury, hemoperitoneum, and an L4 vertebral fracture (Fig. 1C). The patient underwent emergent exploratory laparotomy with evacuation of daughter cysts, cyst unroofing, hypertonic saline lavage, and repair of a jejunal laceration, as well as decompressive craniectomy. Despite aggressive resuscitation and critical care, the patient developed refractory intracranial hypertension and died on postoperative day two, primarily due to severe traumatic brain injury, with hydatid cyst rupture contributing to the overall clinical complexity. Figure 1.Whole-body contrast CT. (A) Left subdural and bilateral subarachnoid hemorrhages with midline shift. (B) Traumatic rupture of a hepatic echinococcal cyst with peritoneal dissemination and active bleeding. (C) L4 vertebral fracture. Clinical discussion: Traumatic rupture of hepatic hydatid cysts is uncommon but is associated with significant morbidity and mortality. Diagnosis may be delayed in polytrauma patients due to competing injuries that obscure clinical signs. Peritoneal dissemination may result in anaphylaxis, sepsis, and recurrence. Even with timely surgical intervention, outcomes are often determined by associated life-threatening injuries, such as severe traumatic brain injury, as in this case. Conclusion: Traumatic rupture of hepatic hydatid cysts should be considered in patients with blunt abdominal trauma in endemic regions. Early imaging, prompt surgical intervention, and a high index of suspicion are crucial. In polytrauma patients, this significantly complicates clinical prioritization and may determine prognosis, even when abdominal contamination is surgically controlled.