Moien A. B. Khan1, Mohamed I. Abusharia2, Hussam M. Mousa3, Fikri M. Abu-Zidan3*

1Departments of Family Medicine, College of Medicine and Health Sciences, UAE University,
2Department of Surgery, Al-Ain Hospital, Al-Ain, United Arab Emirates
3Departments Surgery, College of Medicine and Health Sciences, UAE University,

Keywords: Complications, cutaneous fistula, hydatid cyst, liver


Hepatic hydatid cysts are usually asymptomatic. Nevertheless, they may rupture, causing anaphylactic shock or fistulation. Cutaneous fistulae caused by ruptured hepatic hydatid cysts are extremely rare. Herein, we report a case of infected cutaneous fistula caused by a ruptured hepatic hydatid cyst. A 57-year-old man presented to Al-Ain Hospital complaining of swelling in his right upper quadrant (RUQ) of 5 months’ duration. The abdomen was soft, having a fluctuant tender swelling of 12 cm × 15 cm in the RUQ associated with a pus discharging fistula. The patient was admitted with a provisional diagnosis of abdominal wall abscess with pending sepsis. Surgical incision and drainage were performed under general anesthesia. Initially, around 15 ml of pus was drained, followed by the removal of multiple sized transparent cysts typical of hydatid disease. Postoperative abdominal computed tomography (CT) scan showed multiloculated hepatic cysts in the sixth, seventh, and left lobes with the involvement of the abdominal wall. The patient was treated with oral albendazole 400 mg twice daily for 30 days. Repeated CT scan at 4-month follow-up showed a significant reduction of size of the cysts, indicating proper response to treatment. A cutaneous fistula as a complication of a ruptured hepatic hydatid cyst is extremely rare. Awareness of this complication, especially in endemic areas, and using proper imaging and serological tests are vital for reaching a proper diagnosis.

How to cite this article: B. Khan MA, Abusharia MI, Mousa HM, Abu-Zidan FM. Hepatic hydatid cyst presenting as a cutaneous fistula. Turk J Emerg Med 2020;20:146-8.

Author Contributions

MABK: participated in the idea, read the literature, wrote the first draft of the paper, and approved the final version of the paper. MIA: participated in the idea, operated on the patient, took the intraoperative images, interpreted the data, summarized the case report, took the patient consent for publication, and approved the final version of the paper. HM was the treating consultant surgeon, participated in the idea, read and approved the final version of the paper. FAZ: participated in the idea, interpreted the data, supervised the writing process, repeatedly edited the first version, answered the reviewers and approved the final version of the paper.

Conflict of Interest

There are no conflicts of interest.

Financial Disclosure