Cholecysto-hydatid cyst fistula

Area of Science:

• Hepatology
• Surgical Gastroenterology
• Parasitology

Background:

• Recurrent hydatid cyst of the liver (echinococcosis) poses a significant clinical challenge, particularly after prior surgical interventions.
• Liver echinococcosis can rarely involve adjacent organs, complicating management.
• This case highlights a rare presentation of recurrent hepatic echinococcosis with biliary tract involvement.

Observation:

• A 32-year-old female presented with recurrent liver hydatid cyst 8 years after initial surgery.
• Pre-operative imaging identified a large (110 x 105 mm) hydatid cyst in the right liver lobe.
• Intraoperative findings revealed a 5 mm fistulous tract connecting the hydatid cyst directly to the gallbladder.

Findings:

• The patient underwent a successful surgical procedure comprising endocystectomy (partial cystectomy) of the hydatid cyst.
• A concomitant cholecystectomy was performed due to the fistula.
• The biliary-hydatid fistula was surgically closed, and the residual cyst cavity was obliterated using omentum.

Implications:

• This case demonstrates the feasibility and effectiveness of combined surgical techniques for managing complex recurrent liver hydatid cysts with biliary fistula.
• Successful management underscores the importance of thorough pre-operative assessment and tailored surgical approaches.
• Omental packing provides a reliable method for obliterating residual cavities, minimizing recurrence risk.