A Successful Management of Rare Hepatic Hydatid Cyst Complicated with Multiple Fistulation: A Case Report and Literature Review

Abstract

Hydatid disease is a zoonosis caused by Echinococcus granulosus, most commonly affecting the liver. While biliary rupture represents the most frequent complication, direct rupture into the stomach is an exceptional occurrence. Cysto-gastric fistula constitutes a rare and unusual presentation, often discovered intraoperatively or on advanced imaging. We report a 34-year-old man with no previous medical history who presented with epigastric pain, fever and vomiting of whitish membranes. Clinical examination revealed fever, jaundice and an epigastric mass, with laboratory findings showing neutrophilic leukocytosis and mildly abnormal liver function tests. Imaging demonstrated a giant left hepatic hydatid cyst fistulised into the intrahepatic bile ducts, stomach and duodenal bulb. The patient underwent exploratory laparotomy with resection of the protruding dome, evacuation of hydatid material, closure of cysto-gastric and cysto-duodenal fistulas, cholecystectomy and drainage. Albendazole therapy was administered postoperatively. The postoperative course was uneventful, with no complications at follow-up. This review synthesizes recently reported cases and radiological reviews to analyze the mechanisms, diagnostic features, and surgical management of hepatic hydatid cysts complicated by multi-organ fistulation of a prompt management.