Pseudocholelithiasis in an elderly man with calcified hydatid cysts

Area of Science:

• Gastroenterology
• Parasitology
• Surgical Case Reports

Background:

• Hydatid disease, caused by Echinococcus parasites, can lead to complications like intrabiliary rupture of cysts.
• Intrabiliary rupture of echinococcal cysts is a rare but significant complication, particularly in regions where hydatid disease is endemic.
• Accurate preoperative diagnosis is crucial for effective management, yet can be challenging due to overlapping symptoms with more common conditions.

Observation:

• A 69-year-old male presented with symptoms suggestive of acute cholelithiasis.
• Imaging and clinical presentation revealed an intrabiliary rupture of a calcified echinococcal cyst.
• Despite classic features, the diagnosis was not recognized preoperatively.

Findings:

• The case highlights the diagnostic challenges posed by intrabiliary rupture of echinococcal cysts, which can mimic acute cholelithiasis.
• This complication, while common in endemic areas, is infrequently reported in American literature, with only seven prior cases documented.
• The patient's treatment involved a successful Roux-en-Y drainage procedure, a novel approach for this specific condition.

Implications:

• This case underscores the importance of considering rare parasitic infections in the differential diagnosis of biliary tract disease.
• The successful application of the Roux-en-Y drainage procedure offers a potential new treatment strategy for intrabiliary rupture of echinococcal cysts.
• Further case reports and studies are needed to establish the efficacy and indications for this surgical approach in managing hydatid disease complications.