Giant hydatid cyst involving the right hepatic lobe

Abstract

A 62-year-old woman was being followed up by the Gastroenterology Department [University Hospital Virgen del Rocío, Spain] for a single, small (<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 tumour spanning from the right hypochondrium to the epigastrium. Cholangio-abdominal computed tomography scan and magnetic resonance imaging revealed a 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 and left adrenal cortical adenoma were also observed. She was admitted for total pericystectomy and resection of the right adrenal cyst. The abdominal cavity was washed with diluted hydrogen peroxide. In addition, cholecystectomy and liver resection around cyst margins were 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. She fully recovered and was discharged from hospital one week after the procedure. Postoperative treatment included albendazole for a month, when a follow-up visit was scheduled. Imaging tests showed no cyst recurrence. No medical therapy was needed and she remained asymptomatic.