2317 Accidentally Discovered Cystic Echinococcosis of the Liver

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INTRODUCTION: Cystic echinococcosis (CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptomatic infection to severe, potentially fatal disease. We are presenting a case report of a patient with incidentally discovered liver hydatid disease after he was found to have suspicious liver cystic liver on renal ultrasound. CASE DESCRIPTION/METHODS: A 57-years-old male with history of hypertension and penile pain was referred to the Gastroenterology clinic after he was found to have a possible cystic liver lesion on renal ultrasound. He was originally from Palestine and moved to US 10 years ago. He did not have abdominal pain, icterus, nausea, vomiting or history of recent travel or liver disease. Examination was only relevant for non-tender, non-pulsatile, hepatomegaly with no palpable masses. Labs showed normal liver enzymes. CT Abdomen followed by MRCP showed 11.7 × 10.6 × 9.7 cm cystic mass within the right hepatic lobe, demonstrating multiple non enhancing daughter cysts within in, suggestive of hydatid disease. His serology was positive for Echinococcus granulosus antibodies. After discussion with the patient, he agreed for total cystectomy due to large size of the cyst. During the surgery, once the large cyst was mobilized, daughter cysts were first suctioned through a little puncture hole on the top of the cyst, until the large cavity was totally empty. During excision of the cyst wall, it was found to be tightly adherent to the liver tissue allowing only for excision of anterior cyst wall and omentoplasty. Pathology showed numerous scolexes consistent with Echinococcus Granulosus. He was given Albendazole 2 weeks prior the surgery and 4 weeks after with absence of recurrence on repeated imaging. DISCUSSION: Cystic echinococcosis is often asymptomatic and diagnosed accidentally during radiographic examination, surgery, or during evaluation of other clinical diagnoses. Potential presentations may be due to the mechanical effect of a large cyst on surrounding tissues, rupture of a cyst causing an acute hypersensitivity reaction, or complications such as biliary obstruction. Surgery has long been considered the best, if not the only, option in the treatment. However, in the past two decades, medical treatment, percutaneous procedures, and a “watch and wait” approach have been successfully introduced and have replaced surgery as the treatment of choice in selected cases.