Complicated hepatic cyst with an incidental pelvic hydatid cyst: a case report.

INTRODUCTION: Hydatid disease, a zoonosis caused by Echinococcus granulosus, most commonly affects the liver and lungs. Primary pelvic localization is exceptionally rare (< 2% of cases) and poses significant diagnostic challenges, particularly in patients without classic epidemiological risk factors. This case report highlights the complexities of managing such an atypical presentation.

CASE PRESENTATION: A 56-year-old Arab man from an urban area, with a history of mechanical aortic valve replacement and treatment with warfarin, presented with acute abdominal pain and fever. Imaging revealed a complicated, likely infected hepatic cyst in segment IV and an incidental presacral cystic lesion. Serology was positive for E. granulosus. Emergency laparotomy confirmed that both cysts were hydatid in origin. Management included warfarin reversal, surgical evacuation of both cysts with scolicidal irrigation, and post-operative albendazole therapy. The patient remained healthy, with a good recovery at the 6-month follow-up.

CLINICAL DISCUSSION: The concurrent presence of a symptomatic hepatic cyst and an asymptomatic primary pelvic cyst is rare. This case underscores that hydatid disease can occur in urban patients without a typical exposure history, necessitating a high index of suspicion based on imaging. The acute presentation due to cyst superinfection required urgent surgical intervention. Successful management hinges on meticulous surgical technique to prevent spillage, combined with adjunctive anthelmintic therapy. Long-term surveillance is essential to monitor for recurrence.

CONCLUSION: Hydatid disease should be considered in the differential diagnosis of cystic abdominal masses even in low-risk populations. A structured approach involving timely imaging, careful surgical management, peri-operative albendazole, and prolonged follow-up may be crucial for optimal outcomes in complex, multi-focal cases.