[Hydatid cysts with hepatic and pelvic synchronous location--clinical case]

About 75% of all hydatid cysts are located in the liver and they are singular. Extrahepatic hydatid cysts are rare pre- and intra-operative findings. The majority of such locations are consecutive from a hepatic primary. We present the clinical case of a 28-years woman, clinically diagnosed with a pelvic tumor. Ultrasonography and CT-scan showed two large tumors: a 17/10 cm left liver cyst, that contained free floating hyperechogenic hydatid sand and a 12/11 cm pelvic cyst, that displaced the urinary bladder, the uterus, the sigmoid colon and the rectum. The diagnosis of synchronous hepatic and pelvic hydatid cysts was suggested. Explorative laparotomy revealed a large cystic tumor of the left liver, 20/15 cm, with many daughter cysts. The cysts were aspirated through a closed suction system and flushed with hypertonic saline, then its cavity was unroofed and drained. We also found a voluminous hydatid cyst of the pelvis, which was treated in the same manner. After 2 days, a bile duct communication was diagnosed, with a medium biliary output--300-400 ml/day. The fistulography confirmed the connection with the biliary ducts. An endoscopic sphincterotomy was then performed, followed by a favourable evolution. According to the scientific criterias from the literature, we discussed the treatment and the outcome of these extrahepatic locations.