Giant Abdominal Mass Caused by Disseminated Hepatic Hydatid Disease Leading to Acute Intestinal Obstruction

ABSTRACT

Cystic echinococcosis (CE), stemming from the larval phase of Echinococcus granulosus , poses a grave public health threat in livestock-dense areas. This report details a fatal case of advanced CE in a 47-year-old man presenting with 7-day abdominal distension and obstipation. Abdominal computed tomography revealed multiple cystic lesions inducing small bowel obstruction. Despite supportive care, the patient's status declined, prompting an exploratory laparotomy on December 12, 2023. Postoperative complications, including intra-abdominal hemorrhage and multiorgan failure, led to death on February 8, 2024. These outcomes emphasize CE's severity, and the urgent necessity for enhanced diagnostic and therapeutic approaches against this neglected parasitosis. CE, a significant zoonotic infection caused by the larval stage of the tapeworm E. granulosus , poses a severe public health challenge, particularly in regions with extensive livestock farming. This disease is endemic in several Central Asian countries, notably within the northwest territories of China. In addition, high prevalence rates have been documented in other global regions, including parts of South America, Eastern Europe, the eastern and southern Mediterranean, and specific areas of East Africa. CE can lead to a variety of clinical manifestations, including dissemination to various organs, which is often exacerbated in cases of cyst rupture. A 47-year-old man presented with abdominal swelling and complete cessation of bowel movements for 7 days. Initial assessments, comprising abdominal x-rays and CT scans, revealed multiple cystic formations in the liver and abdominal region, indicative of echinococcosis, coupled with a secondary small bowel obstruction. Despite supportive measures like fasting, gastrointestinal decompression, and parenteral nutrition, the patient's symptoms persisted. On December 12, 2023, an exploratory laparotomy revealed widespread echinococcal disease affecting the liver, spleen, and several other organs. This finding necessitated partial resection of the cyst wall and subsequent drainage. Despite the surgical intervention, the patient experienced postoperative complications such as ongoing intra-abdominal hemorrhage and multiorgan failure. These adverse developments led to a reoperation on December 28, 2023. Ultimately, the patient passed away on February 8, 2024, due to these complications. In conclusion, CE is a serious health concern, especially when it spreads and causes severe complications. If left untreated, the disease can result in fatal outcomes. Future research and clinical focus should aim to improve diagnostic methods and treatments for this often-overlooked parasitic disease. Moreover, enhancing awareness among health care professionals is essential to reduce risks and ensure timely, effective treatment.