Anaesthetic Management of a Large Multiloculated Hydatid Cyst Left Lobe of Liver

Abstract

Hydatid cysts are parasitic infections caused by Echinococcus granulosus and the cysts are mostly found in the liver (65%), followed
by lungs (20%). Single lesions are noted in 75% of patients and are predominantly located within the Right lobe of Liver (80%). Liver Hydatidosis can cause dissemination or anaphylaxis after a cyst rupture into the peritoneum or biliary tract. Infection of the cyst can facilitate the development of liver abscesses and mechanical local complications, such as mass effect on bile ducts and vessels that can induce cholestasis, portal hypertension, and Budd Chiari syndrome. (4) Management varies from medical therapy to percutaneous drainage to surgical intervention. Surgical removal of cysts can be via laparoscopic or open technique however laparoscopic approach may have an increase in the rate of recurrence. Here, we describe a male in his 20s diagnosed with a Multiloculated Hydatid Cyst Left Lobe of Liver underwent Laparotomy followed by Partial Cystectomy under General Anaesthesia with Thoracic Epidural catheterisation & Invasive monitoring. Patient was adequately prepared for the surgery with a high-risk consent with Oral Albendazole started two weeks prior to surgery. Surgery involved major blood loss and stormy post-operative course wherein patient developed Septic Shock, severe metabolic acidosis & was electively ventilated. He was managed with Broad spectrum Antibiotics, IV Crystalloids, Blood transfusion and dual vasopressors. He gradually recovered and was weaned off vasopressors by second post-operative day and was extubated uneventfully. Patient had excellent post-operative recovery started accepting orally well. Good pre-operative preparation, planning and excellent and intensive post-operative critical care support ensured a positive outcome.