Safe surgical management of two concomitant giant hepatic hydatid cysts: a case report

Hydatid disease (HD) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus. The liver is primary affected, accounting for up to 70% of cases, but it can also affect other organs such as the spleen, pelvic cavity, and bones. Patients can remain asymptomatic for 10 to 15 years. This report, accompanied by an extensive literature review, aims to contribute to the understanding of the diagnostic and surgical management of giant hepatic hydatid cysts, given their rarity and the variety of locations in the body where they occur. A 32-year-old male presented with a 3-day history of diffuse abdominal pain. Examination revealed a tense abdomen, and laboratory tests showed mild leukocytosis. Ultrasound and CT scan demonstrated two giant hepatic hydatid cysts. The patient underwent elective open surgery with aspiration of both cysts, instillation of a scolicidal solution, removal of the germinative membranes, and partial pericystectomy with preservation of hepatic tissue. A drain was placed, and the postoperative course was uneventful. He was discharged after 3 days of hospitalization. Albendazole therapy was initiated 2 weeks postoperatively and continued for 6 months. At 6-month follow-up, the patient was asymptomatic with normal liver function tests and no evidence of recurrence on imaging. Our case highlights that despite the limited medical resources in conflict-affected Syria, hepatic hydatid cysts can be successfully managed effectively through a combination of radiological evaluation, open surgical intervention, and antiparasitic drug therapy, resulting in a significant improvement in patient outcomes. Not applicable.