LAUSR

A ten-year-old male child presented with pain abdomen and distension. Examination showed mild icterus and tender hepatosplenomegaly. Investigations revealed leukocytosis, elevated serum bilirubin, alkaline phosphatase and hydatid serology. Ultrasound and Contrast enhanced computed tomogram showed multiple large cystic lesions in both lobes of liver, spleen and dispersed all over the abdomen (Fig. 1a). There were no cysts in the lungs. Preoperative oral albendazole (10 mg/kg) was given for 1 month. Intra-operatively, the entire abdominal wall, liver, spleen and omentumwere studded withmultiple cysts (around 150) (Fig. 1b) which were aspirated and filled with scolicidal agent (20% NaCl) for twenty minutes before removing the endocysts to prevent any spillage. Omentectomy and splenectomy were done in view of multiple cysts (Fig. 1c). Histopathological study revealed hydatid cysts with inner germinal, middle laminated and fibrous outer layer with variable inflammation (Fig. 1d). Post-operative bile leak from liver resolved in about four weeks. Albendazole was given for almost an year post-operatively, at intervals, with regular monitoring of liver function tests. Child has no evidence of recurrence at one year follow-up. Multiorgan involvement of hydatid cysts are rare with only ten cases reported till date in the pediatric age group [1–4]. Two major species, Echinococcus granulosus and E. multilocularis are of medical importance causing cystic and alveolar echinococcosis respectively. The usual destination of this cyclozoonotic parasite is liver via portal vein, however they sometimes reach the right heart and lungs and disseminate to other organs [5]. The symptomatology varies as per the organ system involved. Preoperative imaging reveals unilocular or multilocular cysts with wheel, rosette or honey comb appearance (Fig. 1a) with differentials being amebic and pyogenic liver abscesses [6]. Management continues to be a challenge and aim is to prevent spillage and anaphylaxis intra-operatively. Recurrence due to spillage has been reported in 0–13% [7]. There is no consensus on duration of preand postoperative albendazole therapy specially with such multi-organ involvement. Surprisingly, the index patient had no cysts in the lungs which is an unusual scenario as this cyclozoonotic parasite involves the liver, lungs and then disseminates to other organs [3].