Triple communicating complicated hepatic hydatid cyst: an unusual presentation and laparoendoscopic management

Echinococcal disease in humans had been widely reported in the literature for its unusual presentation and location. We discuss a rare case of suppurated left hepatic hydatid cyst with contaminant transdiaphragmatic rupture communicating into the right pleural cavity along with fistulisation of cyst into the left hepatic duct and stomach which is very rare according to our knowledge. A 65-year-old man presented to us with features of cholangitis and sepsis. Initial radiological investigations revealed multiloculated cystic mass in the left lobe of cirrhotic liver communicating with the left hepatic duct and extending to the right pleural cavity with dilated common bile duct. Endoscopic retrograde cholangiopancreatography confirmed the diagnosis yielding hydatid membranes with presence of transgastric fistula in the left hepatic duct and provided postoperatively continuous internal drainage. Old age, complicated cyst, compromised respiratory status, sepsis and cirrhotic liver precluded us to plan for conservative surgical approach (laparoscopic drainage of mediastinal contents) with successful outcome.