Case ReportHuge echinococcal cyst of the liver managed by hepatectomy: Report of two cases

- Echinococcocal cysts are predominantly located in the right liver. They are usually solitary and asymptomatic, but large cysts can cause compression symptoms. Surgeons in endemic countries usually select conservative approaches because they are relatively easy to perform and have lower morbidity rates. Resection is technically demanding, especially in cases in which cysts are of considerable dimensions like our two reports.
- We report two cases of huge (25 cm and 20 cm in diameter, respectively) echinococcal cysts located in the left liver, which presented as a large palpable mass causing compression symptoms. Diagnosis was established with CT scan showing a cystic mass with the characteristic daughter cysts and reactive layer (pericystic wall) consisting of fibrous connective tissue and calcifications. Both patients were treated radically with left hepatectomy and had uneventful postoperative course and no recurrence upon follow-up.
- The treatment of liver echinococcal cysts represent a unique surgical challenge. Even though conservative approaches are less technically demanding, the radical approach with resection has better outcome with less recurrences, when performed by experienced surgeons. Resection rather than drainage is the management of choice for such huge liver echinococcal cysts.

IntroductionEchinococcocal cysts are predominantly located in the right liver. They are usually solitary and asymptomatic, but large cysts can cause compression symptoms.Case reportsWe report two cases of huge (25 cm and 20 cm in diameter, respectively) echinococcal cysts located in the left liver, which presented as a large palpable mass causing compression symptoms. Diagnosis was established with CT scan showing a cystic mass with the characteristic daughter cysts and reactive layer (pericystic wall) consisting of fibrous connective tissue and calcifications. Both patients were treated radically with left hepatectomy and had uneventful postoperative course and no recurrence upon follow-up.DiscussionThe treatment of liver echinococcal cysts represent a unique surgical challenge. Even though conservative approaches are less technically demanding, the radical approach with resection has better outcome with less recurrences, when performed by experienced surgeons.ConclusionResection rather than drainage is the management of choice for such huge liver echinococcal cysts.