Hepatic and primary mesenteric hydatid cysts in an endemic region: a three-case report with clinicopathological correlation and diagnostic implications

ABSTRACT BACKGROUND: Cystic echinococcosis, caused by Echinococcus granulosus , remains a significant zoonotic infection in endemic regions. Although hepatic involvement is the most common presentation, rare extrahepatic intra-abdominal localizations, such as primary mesenteric hydatid cysts, pose diagnostic and surgical challenges. OBJECTIVE: To describe the clinical, radiological, surgical, and histopathological features of three cases of hydatid disease, including a rare primary mesenteric cyst, and to analyze their diagnostic and management implications in endemic settings. METHODS: This study retrospectively evaluated three cases of hydatid disease diagnosed at the Department of Microbiology, Indira Gandhi Government Medical College and Hospital, Nagpur, India, between January and December 2025. Clinical presentation, imaging findings, operative details, and histopathological results were analyzed. RESULTS: Two patients presented with hepatic hydatid cysts, while one patient had a primary mesenteric cyst without hepatic involvement. Imaging revealed well-defined cystic lesions consistent with a hydatid disease. Histopathology confirmed the diagnosis in all cases by demonstrating laminated membranes and protoscolices/hooklets in the cyst. Surgical excision was performed in all patients, followed by administration of albendazole therapy. No immediate postoperative complications were noted. The follow-up duration was three months, and no recurrence was reported. CONCLUSION: Hydatid disease should remain a key differential diagnosis for cystic intra-abdominal lesions in endemic regions. Rare extrahepatic sites, such as the mesentery, require heightened clinical suspicion. Combined surgical and antiparasitic management remains effective; however, careful intraoperative handling is essential to prevent dissemination.