A Novel Approach to Recurrent Hepatic Hydatid Cyst Using EUS-Guided Aspiration and Ethanol Injection: A Case Report and Focused Literature Review.

BACKGROUND

Hepatic hydatid disease, a manifestation of cystic echinococcosis caused by Echinococcus granulosus, remains endemic in many regions and poses a persistent therapeutic challenge. Although surgery is often employed for definitive management, recurrence, procedural risks, and anatomical constraints have led to growing interest in minimally invasive alternatives such as percutaneous aspiration and endoscopic interventions.

CASE PRESENTATION: We report a 52-year-old male with an incidentally detected hepatic hydatid cyst who initially underwent surgical cystectomy and cholecystectomy. Twenty-five days postoperatively, the patient developed new abdominal fullness, and repeat imaging revealed a cystic lesion in the left hepatic lobe measuring 13.4 × 9.9 cm, reported radiologically as recurrence. The patient underwent endoscopic ultrasound (EUS)-guided fine-needle aspiration and lavage of the cyst cavity with 20 mL of 96% ethanol. The procedure was well tolerated with no adverse events, and follow-up imaging at 6 months confirmed complete cyst resolution.

CONCLUSION

This case demonstrates the technical feasibility and clinical safety of EUS-guided ethanol ablation as a minimally invasive alternative for recurrent hepatic hydatid cysts. It highlights the expanding therapeutic potential of EUS beyond conventional indications and supports further exploration of this technique in selected cases.