HYDATID CYST IN CAUDATE LOBE OF LIVER- A THERAPEUTIC CHALLENGE

Background: Treatment of Echinococcal disease depends on the type, size, and location of the cyst, presence of complications, and the experience of the team. Treatment options include percutaneous treatments, surgery, anti-parasitic drugs, and follow-up without intervention.

Objectives: To report a case of hydatid cyst located in caudate lobe of liver.

Materials and Methods: A 32-year-female, presented with c/o of Pain in abdomen since 1 week localized to right hypochondrium. USG (A+P) was suggestive of hydatid cyst in caudate lobe of liver. MRI was suggestive of hydatid cyst of liver with abutment of left portal vein and IVC. Patient was first started on medical treatment for 6 weeks and then planned for laparoscopic hydatid cyst excision. Cyst was approached laproscopically and fluid aspirated followed by injection of 10% betadine solution (scolicidal) and then reaspirated. Endocyst was removed. The resultant cavity was plugged with omentum.

Results: Patient was discharged on POD-3 on T. Albendazole 400 mg BD for 3 months and T. Praziquantal 600 mg once a week for 3 months. After 6 months, patient is symptomatically well and has no complaints or signs of recurrence at present.

Conclusion: Minimally invasive laproscopic sugery has more or less replaced the conventional open surgical approach for cystic hydatidosis. Our case is unique due to its location in the caudate lobe of liver alongwith abutment and mild compression of IVC and portal vein which poses a therapeutic challenge to the surgeon. The caudate lobe of the liver is an anatomically complex liver segment. Its unique and intimate location with the hepatic hilum and inferior vena cava (IVC) coupled with its dual supply from both portal pedicles and direct venous drainage into the IVC make vascular control a particular challenge. Technically challenging cyst excision can be performed laparoscopically with its benefits of improved perioperative outcomes.