Giant hydatid cyst involving the right hepatic lobe

Abstract

A 62-year-old woman was being followed up by the Gastroenterology Department for a single, small (smaller than 3 cm), uncomplicated liver cyst adequately treated with albendazole for 10 years. Her significant personal history only included hiatal hernia and atrophic gastritis. Abdominal exploration revealed a large, hard, non-fluctuating, painless tumor spanning from the right hypochondrium to the epigastrium; the rest of the abdomen was soft and depressible with no pain or peritoneal signs. Across its diameter the abdominal mass was dull, and peristalsis was preserved. No deglutition changes or dysphagia were present. The patient underwent a cholangio-abdominal CT scan and MRI scan with the following results: hepatic hydatid cyst in the right hepatic lobe, 21 cm in diameter, active, with many vesicles inside, and ruptured at various points, particularly on its inferior aspect with small adjacent cysts. Gallbladder stones. Extrinsic bile duct compression with no dilatation and no choledocholithiasis. Left adrenal cortical adenoma (Fig. 1). The patient was admitted for surgery – total pericystectomy and resection of the right adrenal cyst (Fig. 2). The abdominal cavity was washed with diluted hydrogen peroxide. In addition to this, cholecystectomy and liver resection around cyst margins were also performed, and only a piece of the cortical cyst that was attached to the cava was left in place and fulgurated with argon plasma. The postoperative period was uneventful, including the initial 24 hours spent in the intensive care unit. The patient then fully recovered in the ward, and was discharged from hospital 1 week after the procedure. Postoperative treatment included only albendazole for a month, when a follow-up visit was scheduled. Imaging tests have been made that show no cyst recurrence. For now no medical therapy is needed and the patient remains asymptomatic.