A case report of definitive endoscopic management of a large right liver lobe hydatid cyst - A novel approach.

INTRODUCTION

Cystic echinococcosis is a public health concern worldwide and is endemic in rural communities in South Africa (Shaw et al., 2006). The management of hydatid liver disease is of vital socio-economic importance within the infected communities (Centers for Disease Control and Prevention [Internet]. Echinococcosis). Often, surgical intervention is needed, and this carries its own morbidity and economic burden in our low-to-middle income setting (Acta Trop., 2003). Definitive endoscopic management is rarely considered and offers an exciting option with decreased morbidity to the patient.

PRESENTATION OF CASE

This is a case report of a 36-year-old male who presented with a large right lobe liver hydatid cyst causing abdominal discomfort and pain. He also described early satiety and weight loss with malaise. The symptoms had been present for approximately 8-months duration. The diagnosis of a hydatid liver cyst was made on positive serology and imaging (CE1). The disease was managed with medical treatment using a full course of albendazole initially and then endoscopic drainage into the duodenum using a cautery-enhanced lumen apposing metal stent. There has been no recurrence up to the present time and complete symptom and cyst resolution has been noted.

DISCUSSION

Given the success of this unconventional management, this case report will help in providing a low-morbidity management option in this endemic disease in certain selected cases. It also provides in detail how to use this option as a definitive management pathway.

CONCLUSION

This management option required dynamic thinking and a new application of a revolutionary technology which has changed endoscopic management of a variety of conditions.