A 68-year-old male farmer presented with a history of belching and retrosternal pain, particularly post-prandially. He has a history of keeping stray dogs as pets, raising suspicion for zoonotic infections.
On examination, no significant findings were noted in the general physical examination.

Hydatid Cyst

In USG investigation, incidentally detected a multi-septated complex space-occupying lesion (SOL) in the left liver (segments 2/3), measuring 5.7 × 5.8 × 4.7 cm, with no biliary ductal dilatation. Hydatid serology was Negative. By CECT Abdomen, it is confirmed a multi-septated complex cystic SOL (5.5 × 6 × 4.7 cm) in the left liver, without calcification, nodules, or septal enhancement. CBD was normal. MRCP showed a well-defined multi-septated cystic lesion (6.2 × 5.6 × 5.3 cm) in the left lobe of the liver, mildly compressing the stomach, containing multiple daughter cysts. No cysto-biliary communication was noted.

Hydatid cyst of the liver (segment 2/3) without demonstrable cysto-biliary communication (WHO-IWGE class CE2) was diagnosed.

Hydatid Image -4 F

Management

The patient was initiated on pre-operative albendazole therapy. Subsequently, laparoscopic closed pericystectomy with non-anatomical liver resection was performed. This approach offers several advantages, including improved cosmesis, reduced pain, minimal blood loss, faster recovery, and lower risk of post-operative hernias.
The post-operative course was uneventful, and the patient was discharged on the 5th post-operative day in stable condition.

Discussion

Echinococcosis is a zoonosis caused by larvae of the genus Echinococcus. The cyst can appear in any part of the body but liver is the most common organ which cysts occur. Despite considered as a benign condition, if left untreated, Liver Hydatidosis (LH) might result in complications such as deterioration of life quality or even death. The treatment of LH aims to eliminate parasite completely with minimal morbidity and to prevent recurrence.
Surgery is the gold standard method in the treatment of LH. Although cyst drainage and omentoplasty is a common surgical technique, it is associated with a high likelihood of recurrence. Therefore, in selected patients, total pericystectomy is the only treatment of choice for complete elimination of the parasite.

Hydatid Image - 1 F and 2 F

Conclusion

The patient's post-operative recovery was smooth and uneventful. On post-operative day 1, clear liquids were introduced, and by day 2, the patient was able to tolerate a normal diet without complications. The drain was removed on post-operative day 5, with no evidence of bile leak. Additionally, the post-operative liver function tests (LFTs) were within normal limits on day 5, indicating stable liver function. The patient was discharged in stable condition on the 5th post-operative day, reflecting a successful and uncomplicated recovery.