Disease and Health Research: Recent Developments Vol. 1

Hydatid disease is a zoonosis caused by Echinococcus granulosus, most commonly affecting the liver. The disease is prevalent in Mediterranean, Middle Eastern, and South American regions. Although hydatid cysts may remain silent for years, they can enlarge, become infected, or rupture into adjacent structures. While biliary rupture represents the most frequent complication, direct rupture into the stomach is exceptional. A cysto-gastric fistula is a rare and unusual presentation, often discovered intraoperatively or through advanced imaging. This case report describes a 34-year-old man with no previous medical history who presented with epigastric pain, fever, and vomiting of whitish membranes. Clinical examination revealed fever, jaundice, and an epigastric mass, while laboratory findings showed neutrophilic leucocytosis and mildly abnormal liver function tests. Imaging demonstrated a giant left hepatic hydatid cyst fistulised into the intrahepatic bile ducts, stomach, and duodenal bulb. The patient underwent exploratory laparotomy with resection of the protruding dome, evacuation of hydatid material, closure of the cysto-gastric and cysto-duodenal fistulas, cholecystectomy, and drainage. The patient also received adjuvant medical therapy with albendazole. The postoperative course was uneventful, with no complications during follow-up. This report synthesises recently reported cases and radiological reviews to analyse the mechanisms, diagnostic features, and surgical management of hepatic hydatid cysts complicated by multi-organ fistulation, emphasising the need for prompt management. Cysto-gastric and cysto-duodenal fistulisation represent exceptionally rare but potentially life-threatening complications of hepatic hydatid disease. Surgical management remains the cornerstone of treatment, with the objectives of cyst evacuation, fistula closure, prevention of peritoneal contamination, and management of associated biliary complications. Early diagnosis and prompt multidisciplinary management are essential for achieving favourable outcomes, even in complex presentations involving multiple gastrointestinal fistulas.