Infected hydatid cyst of the liver presenting as retroperitoneal abscess

Abstract

Introduction

Hydatid disease is most frequently located in the liver. Complications are not uncommon and can be life-threatening. Retroperitoneal growth of a hepatic hydatid cyst is an exceptional event; bacterial infection within the cyst may mimic a retroperitoneal abscess.

Case report

A 44-year-old man was admitted to the emergency department for right lumbar pain and fever. Computed tomography revealed a large infected hydatid cyst of the liver with an unusual expansion in the retroperitoneum. The lesion was managed surgically by evacuation of the purulent fluid and partial cystectomy through a midline laparotomy. A biliary fistula emerged the first day after surgery and dried up after a month. Albendazole was administered postoperatively for six months. No recurrence was recorded after two years of follow-up.

Conclusion

Large infected hydatid cyst of the liver with retroperitoneal growth is a rare presentation. Differential diagnosis with right upper retroperitoneal abscesses and management are challenging. Medical imaging plays a key role in the diagnosis. Surgery via transperitoneal approach seems to be the best therapeutic method, and conservative surgical procedures are preferred for their safety and simplicity, especially when the lesion progresses and adheres to retroperitoneal structures.