“A Large Incidentally-Diagnosed Left-Lobed Hepatic Hydatid Cyst in a Young Male Patient”

Abstract

Introduction: Despite modern healthcare facilities, hydatid disease (HD) remains a perpetuating public health problem in endemic countries. Infection with Echinococcus may have a diverse clinical evolution, leading even to hepatic transplantation in the case of unresectable cysts. The current therapeutic options comprise conservative management with antiparasitic drugs, percutaneous drainage and surgical excision.

Case description: We present the case of I.D., a 28 year-old male who was admitted for cephalalgia, vertigo and localized tenderness in the right hypochondrium. Physical examination revealed an enlarged cranio-caudal diameter of the liver, with pain elicited upon palpation. Laboratory results showed slightly elevated alanine aminotransferase (ALT) (46 U/L) and hypercholesterolemia (268 mg/dl). The patient was booked for cerebral and abdominal magnetic resonance imaging (MRI). A class CE III hepatic hydatid cyst with dimensions of 8.7/8 centimeters located in the second and third Couinaud segments of the left hepatic lobe was diagnosed incidentally and confirmed with serology (Anti-Echinococcus IgG antibodies value of 29 U/L). The patient underwent radical surgical excision followed by an uneventful recovery.

Discussion:. Among the various therapeutic approaches available, radical surgical removal has the lowest rate of recurrence and complications. This case demonstrates, that in endemic countries, physicians should have a higher index of suspicion of HD in patients with right hypochondrial pain, hepatomegaly and raised ALT.

Keywords: hydat id cyst, hepatic, liver, Echinococcus, cystectomy, radical surgical treatment