Avtor/Urednik		Lešničar, Gorazd; Vlaović, Miodrag; Gadžijev, Eldar M; Radič, Željko
Naslov		Anafilaktični šok po travmatski rupturi jetrne ehinokokne ciste v trebušno votlino
Prevedeni naslov		Anaphylactic shock after traumatic rupture of hepatic echinococcal cyst into the abdominal cavity
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 66, št. 7-8
Leto izdaje		1997
Obseg		str. 355-8
Jezik		slo
Abstrakt		Background. In literature examples of anaphylactic shock as a consequence of a rupture of the echinococcal liver cyst after blunt abdominal trauma are rarely found. Mortality in such cases is high and its cause, because of frequently clinically inaparent echinococcosis is unfortunately found out not earlier but by the pathologist. Methods. The course of the treatmet of an 13 years old boy is described who fell with his abdomen on the ball when playing soccer. Immediately after the fall an anaphylactic shock set in. After a successful reanimation, urgent surgical intervention - cystopericystetomy in the segment VII. of the liver and local scolicidal and systemic antiparasitic treatment, the patient survived. Results. In spite of all the previous treatment and the patient's well feeling two years after surgical intervention a recidive of an echinococcal cyt was found on the primary site with follow up ultrasound (UZ) and computed tomography (CT). Because of unsuitable anatomic position and abundant bleeding it had been impossible to extirpate the pericyst totally during primary surgical intervention. In 1996 a repeated surgical intervention was performed - subtotal pericystectomy was well endured by the patient. In spite of albendazol prophylaxis a recidive of echinococcal cyst was repeatedly established at the and 1996 in the same locality of the liver. The course of disease is still followed up. Conclusions. In spite of local upraise of recidive of an exhinococcal cyst we believe that with an adequate surgical and systemic drug treatment we succeeded in prevention of dissemination of the disease in the patient. Although echinococcosis in Slovenia is relatively rare in differential diagnosis of etiologicaly unexplained systemic allergic reactions a possible secret parasitic disease should be considered.
Izvleček		Izhodišča. V literaturi zelo redko zasledimo primere anafilaktičnega šoka kot posledice rupture jetrne ehinokokne ciste po topi abdominalni poškodbi. Umrljivost je v teh primerih zelo velika, vzrok smrti pa zaradi klinično pogosto prikrite ehinokokoze žal ugotovi šele patolog. Metode. Opisali smo potek zdravljenja pri 13-letnem dečku, ki je pri igranju nogometa s trebuhom padel na žogo. Takoj po padcu je nastopil anafilaktični šok. Po uspešnem oživljanju, urgentnem kirurškem posegu - cisto-pericistektomiji v VII. segmentu jeter in lokalnem skolicidnem in sistemskem antiparazitarnem zdravljenju, je bolnik ostal pri življenju. Rezultat. Kljub temu da se je bolnik nato počutil zdravega, smo dve leti po kirurškem posegu ultrazvočno in z računalniško tomografijo ugotovili recidiv ehinokokne ciste na primarnem mestu, kjer ovojnic zaradi neprikladne anatomske lege in obilne krvavitve ni bilo mogoče povsem izrezati. V začetku l. 1996 je bil opravljen ponovni kirurški poseg - subtotalna pericistektomija, ki jo je bolnik dobro prestal in je sedaj brez težav. Kljub profilaksi z abendazolom smo ob koncu leta 1996 ugotovili na istem mestu jeter ponoven recidiv ehinokokne ciste. Bolezenski potek še spremljamo. Zaključki. Kljub lokalnemu recidivu ehinokokne ciste menimo, da smo z ustreznim kirurškim in sistemsko medikamentnim zdravljenjem uspeli pri bolniku zavreti možnost napredovanja bolezni. Čeprav je ehinokokoza v Sloveniji relativno redka, moramo v diferencialni diagnostiki etiološko nepojasnjenih sistemskih alergičnih reakcij pomisliti tudi na možnost prikrite parazitarne bolezni.
Deskriptorji		ECHINOCOCCOSIS, HEPATIC RUPTURE ANAPHYLAXIS ABDOMINAL INJURIES WOUNDS, NONPENETRATING