Combined endoscopic and laparoscopic approach to a giant hepatic hydatid cyst with biliary compression: A case report

Abstract

Introduction

Hepatic hydatid disease caused by Echinococcus granulosus remains a significant health burden in endemic regions. Giant cysts may cause compression of adjacent structures, complicating both diagnosis and surgical management. Minimally invasive techniques combined with preoperative endoscopic intervention offer a safe and effective therapeutic option in selected cases.

Case presentation

This report describes a 45-year-old female from a rural area presenting with a two-year history of progressive epigastric pain, vomiting, anorexia, and weight loss. Physical examination revealed an epigastric mass and mild jaundice. Laboratory investigations showed elevated inflammatory markers (CRP 181 mg/L), elevated cholestatic enzymes (ALP 215 U/L, GGT 164 U/L), mild hyperbilirubinemia (total bilirubin: 2.1 mg/dL; direct bilirubin: 1.6 mg/dL) and a positive ELISA for E. granulosus. Abdominal CT revealed a well-demarcated, multilobulated cystic lesion measuring 20 × 12 × 12 cm, predominantly in the right hepatic lobe, extending into the left lobe and compressing the common bile duct (CBD), duodenum, pancreas, and lesser curvature of the stomach. ERCP demonstrated external compression of the CBD, and a plastic stent (10 Fr) was placed after balloon clearance of sludge. Albendazole (400 mg BID) was initiated preoperatively. Four days later, laparoscopic exploration confirmed a giant hydatid cyst occupying segments V-VIII and II-III. Laparoscopic endocystectomy with omentoplasty was performed without spillage. The postoperative course was uneventful, and the patient was discharged on postoperative day four. She remained asymptomatic at four months follow-up.

Discussion

This case highlights the role of combined endoscopic and laparoscopic intervention in managing large, compressive hepatic hydatid cysts. Preoperative biliary decompression reduces the risk of postoperative biliary fistula, while laparoscopic endocystectomy offers excellent outcomes in most patients, minimizing surgical trauma.

Conclusion

A combined endoscopic and laparoscopic approach can be safely and effectively applied in the management of giant hepatic hydatid cysts with biliary compression, providing favorable clinical outcomes and reduced perioperative morbidity.