Laparoscopic drainage of a hepatic echinococcal cyst: a case report

Abstract

The Echinococcus granulosus tapeworm causes hepatic echinococcosis. It is endemic in the Mediterranean region, Middle East, and South America. Human infection is secondary to accidental consumption of ova in feces. Absorption through the bowel wall and entrance into the portal circulation leads to liver infection. This case involves a 34 y/o Moroccan male with an echinococcal liver cyst. His chief complaint was RUQ pain. The patient was treated with albendazole and praziquantel. His PMH and PSH was noncontributory. Patient was not on any other medications. ROS was otherwise unremarkable. The patient was AF VSS. He was tender to palpation in RUQ. Liver function tests were normal. Echinococcal titers were positive. CT demonstrated a large cystic lesion in the right lobe of the liver measuring 13.5 cm in diameter. The patient underwent successful laparoscopic drainage and excision of echinococcal cyst. Final pathology demonstrated degenerating parasites (E. granulosus) of echinococcal cyst.

Figure 1

CT after 3 month course of albendazole and praziquantel.

Figure 2

Trocar placement.

Figure 3

Cyst surrounded by hypertonic saline-soaked pediatric laparotomy pads.

Figure 4

Aspiration of cyst contents and instillation of hypertonic saline.

Figure 5

Excision of cyst wall using a harmonic scalpel.

Figure 6

Excision of cyst wall using endo-GIA stapler with 2.5 mm vascular loads.