Case Series: Intraoperative Anaphylaxis and Preventive Measures in Hydatid Cyst Surgery

Abstract

Background:

Hydatid disease caused by Echinococcus granulosus remains a considerable surgical and

anesthetic challenge in endemic areas. One of the most feared intraoperative complications is anaphylaxis due to rupture or spillage of cyst contents, which can rapidly progress to

Cardiovascular collapse and even death. Prompt recognition, timely intervention, and preventive strategies are essential for safe patient outcomes.

Case Series:

We report three cases of hepatic hydatid cyst surgery that illustrate the varying severity of intraoperative reactions. The first case involved a 50-year-old female with a large right lobe

cyst who developed fulminant anaphylaxis characterized by severe hypotension, tachycardia, desaturation, and bronchospasm. She required aggressive resuscitation with adrenaline

boluses, infusion, corticosteroids, inotropes, and elective postoperative ventilation before making a complete recovery. The second case involved a 60-year-old male with a

multiloculated cyst of the right hepatic lobe who experienced transient intraoperative hypotension during cyst aspiration. His blood pressure responded promptly to intravenous fluids, phenylephrine, and hydrocortisone, and he remained stable with an uneventful postoperative course. The third case was a 45-year-old female with a unilocular cyst in the left lobe of the liver. She received preoperative albendazole, perioperative steroid and

antihistamine prophylaxis, and surgery was performed with meticulous preventive measures, including controlled aspiration and scolicidal irrigation. No intraoperative reaction occurred, and recovery was smooth.

Conclusion:

This case series demonstrates the unpredictable spectrum of anaphylaxis in hepatic hydatid surgery. Preparedness with adrenaline and resuscitation protocols, combined with prophylaxis and careful surgical technique, remain the cornerstones of anesthetic management.