EAES Academy

The hydatid disease is a serious ailment caused by the parasite Echinococcus granulosus and can have multiple complication that can sometimes prove lethal. The parasite is usually found in endemic areas and the disease involves the liver in more than 75% of cases, but the cysts can be found almost anywhere in the body. Hydatid cysts are often asymptomatic and are in most cases discovered incidentally or in advanced stages of the disease due to complications arisen from metastases or rupture. Computed tomography (CT) remains the most valuable investigation for assessing complications and individual treatment planning. The surgical approach is open or, in selected cases, minimally invasive, while endoscopic retrograde cholangiopancreatography (ERCP) is an effective method of treatment for liver hydatid cysts with biliary fistulae.
This report presents a case of primary hydatid cysts located in the liver successfully treated by a tailored surgical approach, combining open and minimally invasive techniques and ERCP. An 18 year-old female patient with a giant hepatic cyst ruptured in the peritoneal cavity was admitted in the General Surgery Department with diffuse abdominal pain, but without any associated anaphylactic reactions. The patient exhibited non-specific clinical presentations and was submitted to several surgical procedures, minimally invasive combined with endoscopic procedures (billiary stent by ERCP) combined with antiparasitic agents. Follow-up at 6 months showed complete eradication of the parasite.
This case underlines the need for individually customized treatment in order to minimize the complications and successfully cure the disease.