The Puncture, Aspiration, Injection and Re-aspiration (PAIR) Technique of Hepatic Hydatid Cyst: A Case Report and Review of Literature.

Hydatid disease, caused by Echinococcus granulosus, commonly affects the liver and can lead to complications such as rupture, secondary infection, and anaphylaxis. While surgery is the traditional treatment for complicated cases, minimally invasive techniques are emerging as viable alternatives. We report a case of a 27-year-old female with a history of gastritis and a pancreatic cyst who presented with acute diffuse abdominal pain and nausea. Imaging revealed an 11.8×8.8×5.2 cm cystic structure in the left hepatic lobe, consistent with a hydatid cyst, with free intraperitoneal fluid concerning for an impending or near rupture. The patient underwent percutaneous drainage of the cyst (puncture, aspiration, injection, and re-aspiration, PAIR technique), yielding 300 cc of serosanguinous fluid. She was started on albendazole therapy and closely monitored. Over nine days of hospitalization, her condition improved, drainage output decreased, and she was discharged in stable condition with a structured follow-up plan. Our report demonstrates that percutaneous drainage with adjunctive albendazole therapy is a feasible and effective alternative to surgery in hemodynamically stable patients with ruptured hepatic hydatid cysts. Further studies are warranted to refine patient selection criteria and optimize long-term outcomes.