{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T02:42:35Z","timestamp":1768444955136,"version":"3.49.0"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,4,16]]},"abstract":"<jats:p>A 65-year-old man with hydatid disease of the liver presented with a spontaneous cutaneous rupture draining about 10\u2005L of fluid with daughter cysts. Contrast-enhanced CT showed multiple hypodense areas in the residual right lobe of the liver and abdominal wall with compensatory hypertrophy of the left lobe, confirming the diagnosis of a hydatid cyst presenting as external fistulisation which represents a very advanced stage of hydatid disease. Once the patient's nutritional status improved he was taken for surgery. On laparotomy there were multiple cysts seen in the residual right lobe of the liver and inflammatory changes in the abdominal wall with an external fistulous opening. Right-lobe hepatectomy was carried out along with excision of the fistulous tract. The specimen showed multiple degenerated contents of the cyst with numerous daughter cysts along the fistulous tract and examination of cyst fluid demonstrated protoscolices. The postoperative period was uneventful. He was regularly followed and was doing well.<\/jats:p>","DOI":"10.1136\/bcr-2014-203784","type":"journal-article","created":{"date-parts":[[2014,5,14]],"date-time":"2014-05-14T10:49:45Z","timestamp":1400064585000},"page":"bcr2014203784","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Spontaneous external fistula: the rarest presentation of hydatid cyst"],"prefix":"10.1136","volume":"2014","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0490-7323","authenticated-orcid":false,"given":"Kumar","family":"Jayant","sequence":"first","affiliation":[{"name":"Department of General Surgery, Sudha Hospital & Medical Research Centre, Kota, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swati","family":"Agrawal","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sudha Hospital & Medical Research Centre, Kota, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajendra","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sudha Hospital & Medical Research Centre, Kota, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krishna Gopal","family":"Dayama","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Sudha Hospital & Medical Research Centre, Kota, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,5,14]]},"reference":[{"key":"2025082703062380000_2014.may14_1.bcr2014203784.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2006.02.022"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0399-8320(04)95139-1"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.3","doi-asserted-by":"crossref","first-page":"697","DOI":"10.9738\/1364.1","article-title":"Hydatid disease presenting as cutaneous fistula: review of a rare clinical presentation","volume":"96","author":"Korwar","year":"2011","journal-title":"Int Surg"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.4","first-page":"267","article-title":"Spontaneous cutaneous-cystic-hepatic-bronchial fistula due to a hydatid cyst","volume":"65","author":"Kehila","year":"1987","journal-title":"Tunis Med"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.5","first-page":"344","article-title":"Subcutaneous rupture of a hydatid cyst of the liver","volume":"40","author":"Borras","year":"1958","journal-title":"Med Esp"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.6","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.3309"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.7","doi-asserted-by":"crossref","first-page":"2993","DOI":"10.4318\/tjg.2009.0033","article-title":"Spontaneous cutaneous fistula of an infected liver hydatid cyst","volume":"20","author":"Yakan","year":"2009","journal-title":"Turk J Gastroenterol"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0399-8320(05)88218-1"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2009.11.001"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2006.02.018"},{"key":"2025082703062380000_2014.may14_1.bcr2014203784.11","unstructured":"Kjossev K Belokonski E Vladov N . TN (R) C points system for cystic echinococcosis: clinical evaluating and monitoring of the disease. Proceedings of 44th Congress of the European Society for Surgical Research Nimes, France\/May 20\u201323. 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