{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T15:06:51Z","timestamp":1776784011219,"version":"3.51.2"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Liver hydatid cysts represent a significant health concern globally, particularly in endemic regions like Tunisia. While they often lead to complications such as biliary fistulas, diagnostic errors can arise from radiologic signs like the \u201cMercedes Benz sign,\u201d which indicates gas within the gallbladder. This report highlights the challenge of diagnosing a rare cholecysto-hydatid cyst fistula, where the presence of gas in the gallstones initially suggested a fistula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>A 30-year-old female presented with right hypochondrium pain and fever. Ultrasound suggested cholecystitis and identified two cystic formations in liver segments IVb and VII. CT scan revealed intravesicular air bubbles, suggesting a cholecysto-hydatid fistula. Emergency surgery was performed. Intraoperatively, there was an acute cholecystitis. The liver hydatid cyst of segment IVb communicated with the biliary tree and there was no cholecysto-hydatid fistula. We performed a cholecystectomy, cholangiography, and a total pericystectomy for the two liver hydatid cysts. The postoperative follow-up was uneventful.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>The \u201cMercedes Benz sign,\u201d often indicating gas within gallstones, is rare but can mislead the diagnosis toward a cholecysto-hydatid cyst fistula. This case highlights the diagnostic challenge posed by this radiological feature, which led to initial suspicion of a fistula. Hydatid cysts, though common in endemic regions, can lead to diagnostic dilemmas, especially when atypical signs are present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The presence of gas in the gallbladder can mislead the diagnosis, particularly when the \u201cMercedes Benz sign\u201d is present, as it may suggest a rare cholecysto-hydatid cyst fistula. However, this is not always the case. Prompt and accurate evaluation, including intraoperative findings, to reinforce clinical suspicion and decision-making in endemic regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.110416","type":"journal-article","created":{"date-parts":[[2024,10,4]],"date-time":"2024-10-04T18:07:20Z","timestamp":1728065240000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Misleading Mercedes-Benz sign: A case report of misdiagnosed cholecysto-hydatid cyst fistula in acute cholecystitis"],"prefix":"10.1097","volume":"124","author":[{"given":"Mohamed Ali","family":"Chaouch","sequence":"first","affiliation":[{"name":"Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed Hadj","family":"Taieb","sequence":"additional","affiliation":[{"name":"Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Besma","family":"Gafsi","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Monastir University Hospital, Monastir, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Zayati","sequence":"additional","affiliation":[{"name":"Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofien","family":"Gaied","sequence":"additional","affiliation":[{"name":"Department of Radiology, Monastir University Hospital, Monastir, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faouzi","family":"Noomen","sequence":"additional","affiliation":[{"name":"Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"4","key":"R1-97-20260421","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s12639-019-01140-4","article-title":"Daughter cyst sign in liver hydatid cyst","volume":"43","author":"Chaouch,","year":"2019","journal-title":"J Parasit Dis. d\u00e9c"},{"issue":"1","key":"R2-97-20260421","first-page":"92","article-title":"Liver hydatid cyst complicated by biliary and colonic fistula diagnosed after intra-operative cholangiography","volume":"2","author":"Nacef,","year":"2017","journal-title":"Surg Infect Case Rep."},{"issue":"5","key":"R3-97-20260421","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi,","year":"2023","journal-title":"Int J Surg Lond Engl."},{"issue":"8","key":"R4-97-20260421","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s00268-004-7516-z","article-title":"Treatment of hydatid cyst of the liver: where is the evidence?","volume":"28","author":"Dziri,","year":"2004","journal-title":"World J Surg. ao\u00fbt"},{"issue":"3","key":"R5-97-20260421","doi-asserted-by":"crossref","first-page":"01","DOI":"10.31491\/CSRC.2019.09.001","article-title":"Preoperative predictive factors of liver hydatid cyst occult or frank intrabiliary rupture","volume":"3","author":"Dougaz,","year":"2019","journal-title":"Clin Surg Res Commun."},{"key":"R6-97-20260421","first-page":"1","article-title":"Rupture of hydatid cyst in the gallbladder leading to acute cholangitis. Cui D, \u00e9diteur","volume":"2021","author":"Elmajdoubi","year":"2021","journal-title":"Case Rep Infect Dis"},{"issue":"3","key":"R8-97-20260421","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1148\/radiographics.20.3.g00ma06795","article-title":"Hydatid disease: radiologic and pathologic features and complications: (CME available in print version and on RSNA link)","volume":"20","author":"Pedrosa,","year":"2000","journal-title":"RadioGraphics. mai"},{"issue":"5","key":"R10-97-20260421","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s12262-020-02630-z","article-title":"The Mercedes Benz sign on magnetic resonance cholangiopancreatography","volume":"84","author":"Yelamanchi","year":"2022","journal-title":"Indian J. 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