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hydatid cyst is a serious parasitic infection in places which people has a close contact with dogs or sheep ( 1 ) .
mehmet yilmaz and et al . mentioned that these cysts ordinary have a chronic , latent , and asymptomatic course which are developed more frequently in liver ( 50%77% ) and lungs ( 18%35% ) , while may be formed in other organs .
they may be found as an incidental findings during routine clinical examination or even followed by radiographic or ultrasonography ( us ) evaluation ( 2 ) .
the disease becomes more complicated if rupture of the cysts occurs due to blunt trauma or spontaneously increases of intra - cystic pressure ( - ) .
hydatid cysts may be directly ruptured into the peritoneal cavity or via the diaphragm into the pleural cavity .
ruptures can also occur into the hollow viscous or even biliary tract ( 7 ) .
however , hydatid cyst rupture requires proper treatment consists of emergency surgery and also special postoperative care . here
, we reported a case of hydatid liver cyst ( hlc ) that ruptured into the peritoneal cavity after blunt abdominal trauma .
his blood pressure was 100/60 mmhg , heart rate of 80 per minute , respiratory rate 23 breath per minute and axillary temperature of 37.2 c , and oxygen saturation of 96% on room air . on physical examination ( pe ) only right upper abdominal pain and rebound tenderness were observed .
twenty minutes after admission , a diffuse urticarial rash on the whole body , mainly on his face and trunk , and generalized tenderness were noted .  
the patient received oxygen , intravenous fluid ( ringer and dexter an -saline serum ) in addition to intravenous steroids ( hydrocortisone 200 mg ) and antihistamines ( chlorpheniramine 20 mg ) as the supportive treatment .
focused abdominal sonography for trauma ( fast ) of his abdomen demonstrated on the presence of free fluid noted in all abdominal quadrants , especially in the morison pouch ( figure 1 ) . also by using ultrasonography a large hyperechogenic area with local cystic ( 40 mm diameter ) in the right lobe of the liver
laparotomy revealed a ruptured cystic mass within the right lobe of the liver and yellow fluid containing daughter cysts and liver laceration .
the cyst was removed by an open right partial hepatectomy , the peritoneal cavity washed out with hypertonic saline , and a tube drain placed in right the sub - hepatic space .
he was managed in intensive care unit ( icu ) and received oral albendazole 15mg / kg / day .
he was discharged ten days post - operation with a prescription of albendazole tablet 15mg / kg / day in divided dose for six months .
he was kept well and control trans - abdominal ultrasonography demonstrated no recurrences of the disease .
this disease is endemic in sheep farming areas including the middle east and some sub - saharan countries , western europe , south and central america .
hydatid cyst is also endemic in iran and is responsible for about 1% admission in surgical wards ( 8) .
twenty - four hydatid cyst operations were performed in babol , iran , from 1991 to 1996 ( 9 ) . in e. granulosus life cycle , human is an accidental intermediate host considered as a dead end host . generally , the disease in most cases remains silent for many years but it becomes problematic when it getting large enough or ruptured .
rupture into the peritoneal cavity can be accompanied by abdominal pain , urticaria , anaphylaxis reaction , and sometimes sudden death ( 2 ) .
rupture of a hydatid cyst particularly after blunt abdominal trauma has been rarely reported . based on our best knowledge ,
there are a few reports on rupture of hydatid cyst after blunt trauma in iran . for example , a ruptured hydatid cyst was reported in 23-year - old man who was presented to the emergency unit after blunt trauma to his abdomen .
he had abdominal pain , vomiting , and nausea with generalized itching without urticaria rash ( 10 ) .
hossinian and colleagues reported a giant cardiac hydatid cyst , which ruptured left ventricular free wall in a 24-year - old man admitted to the department of cardiothoracic .
he complained of chest pain which started suddenly and became progressively intense during the time in addition to periodic thoracic pains during regular activities in the past 6 months ( 11 ) .
trans - abdominal ultrasonography is a very sensitive method to demonstrate the hydatid cyst rupture ( 12 ) .
however , primary suspicions of intra - peritoneal ruptured hydatid cyst obtained by clinical manifestation and trans - abdominal ultrasonography was further confirmed by laparotomy . the main method in the treatment of hydatidosis is surgery classified to radical and non - radical ( conservative ) methods . each method has some advantages and disadvantages and
there is no information about the most efficient surgical approach in intra - peritoneal perforation of hydatid cysts . but some authors mentioned that conservative methods may have satisfactory results in an emergency situation .
however , choosing of a surgical method depends on patient s condition and preference of the surgeon ( 13 ) .  
recurrence is an important risk in hydatidosis and may occur frequently after treatment of ruptured hydatid cysts ; therefore , all patients should be followed - up carefully in postoperative period ( 4 )
. intra - peritoneal rupture of hydatid cysts should be considered in the differential diagnosis of acute abdominal pain with vomiting and urticarial rash in the endemic areas .
clinicians working at the emergency department should be alert regarding the rupture of hydatid cyst in the patients with acute post traumatic peritonitis and its related signs and symptoms .
all authors passed four criteria for authorship contribution based on recommendations of the international committee of medical journal editors .
hydatid cyst is a serious parasitic infection in places , which people has a close contact with dogs or sheep 
 . they may be found as an incidental findings during routine clinical examination or even followed by radiographic or ultrasonography evaluation . 
 the disease becomes more complicated if rupture of the cysts occurs due to blunt trauma or spontaneously increases of intra - cystic pressure . here 
 , we reported a case of hydatid liver cyst that ruptured into the peritoneal cavity after blunt abdominal trauma .