Giant Hydatid Cyst with Diaphragmatic, Pericardial, and Hepatic Involvement: Use of Extracorporeal Circulation for Major Liver Resection: A Case Report and Literature Review

Patient: Male, 32-year-old Final Diagnosis: Cyst • echinococcosis • echinococcus infection • hepatic hydatid • hydatid cyst • hydatid cyst disease Symptoms: Abdominal pain • abdominal distension • fever • mass in abdomen Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Infectious Diseases • Surgery OBJECTIVE: Rare disease BACKGROUND: Echinococcosis is a zoonosis caused by the echinococcus microorganism, a parasite with 6 described species in the literature, the main one in humans being Echinococcus granulosus. Transmission is via the fecal-oral route, with main hepatopulmonary involvement but with high risk of dissemination. Diagnosis is often incidental and patients present a wide range of non-specific symptoms, closely related to localization, size, and quantity of cysts. The latent risk of the infection is septic shock secondary to intraperitoneal rupture, which increases the risk of mortality. The criterion standard of management involves anthelmintic therapy and radical surgical management. CASE REPORT: We present the case of a man in the third decade of life from a rural area of Colombia, presenting abdominal pain and febrile peaks for 2 months. Imaging studies showed a cystic lesion with thoracic and hepatic involvement. He was treated in 2 surgical stages, the first achieving partial resection of the cyst involving lung, diaphragm, and rib cage, and the second with extracorporeal circulation assistance due to infiltration of the retrohepatic vena cava, achieving radical resection of the disease. CONCLUSIONS: Echinococcosis is a condition endemic to rural areas, with wide geographical distribution. Given the slow growth, it is mostly asymptomatic, which causes diagnostic and therapeutic challenges involving high rates of complications and mortality. An individualized surgical and medical approach is recommended. Extracorporeal circulation assistance helps achieve hemodynamic stability in patients with cardiac or great vessel involvement. To the best of our knowledge, this is the first report of extracorporeal circulation assistance for large hepatic-diaphragmatic and pericardial cyst resection.