A 92-year-old woman from a rural area with no history of interest was admitted because in the last weeks she noticed an increase in abdominal perimeter, jaundice, choluria and acholia accompanied by dysthermic sensation.
On admission, laboratory tests revealed a pattern of stasis and leukocytosis with left shift.
Abdominal ultrasound showed a large lesion consisting of multiple cystic cavities of different dimensions, occupying almost the entire right hepatic lobe, displacing the gallbladder toward hypogastrium.
With the suspicion of multivesicular hydatid cyst, abdominal CT is performed confirming the finding, with findings suggestive of rupture and peritoneal sowing, as well as marked dilatation of the intrahepatic and extrahepatic bile duct.
Serology confirmed the positivity for hydatidosis (1/2,560).
ERCP was performed, cannulating the bile duct selectively, without observing bile duct repletion defects.
After endoscopic sphincterotomy, bile strictures were obtained, cleaning the bile duct.
After initiating treatment with albendazole and praziquantel, surgical intervention is performed, objectifying during the same biliocystic communications.
After performing cystopericystectomy, the fistulas were explored with Fogarty and a Kher tube was placed in the larger fistula that reached the right liver, leaving two Pezzer ducts.
The patient improved clinically and analytically, showing high distress and hemodynamically stable.
