Hydatid disease cured by minimally invasive therapy

Hydatid disease is relatively frequently encountered in general surgery services (4-5% of the total operated cases). The association of the hepatic and pulmonary localizations is quite common, but the involvement of more organs is rare. The asymptomatic rupture of the hydatid cyst in the peritoneal cavity is exceptional. We present the case of a 69-year old female patient who was hospitalized in the 1st Surgical Clinic for irritative dry cough, loss of weight (4 kg in the last 3 months), fatigue, itching and dyspnea. She had been hospitalized in a department of internal medicine for respiratory symptoms when, during X-ray investigation, an opacity was observed, which was suggestive for a pulmonary hydatid cyst. The abdominal ultrasound revealed a multiple hydatid localization (liver, spleen, lower right abdominal quadrant and hypogastrium) and the patient was sent to our clinic. The patient was treated with albendazole 10 mg/kg/day for 10 days before surgery. Surgery was performed by a minimally invasive approach, first by thoracoscopy and, in the same operative session, the other hydatid localizations were approached by laparoscopy. The parasiticide treatment was continued about 3 months after surgery, when the patient was hospitalized again in order to cure the splenic hydatid cyst. Postoperative evolution was complicated by a biliary fistula which resolved spontaneously in 10 days after the intervention. The postoperative hospital stay was 14 days. This case was unusual because of the paucity of symptoms in spite of the multiple abdominal cysts and because it was cured by a modern, minimally invasive approach.