A rare complication of the hydatid cyst of the liver: A case report of Cysto-cutaneous fistula

Abstract

Hepatic Hydatid cyst of the liver is a parasitic zoonotic illness caused by Echinococcus granulosus that remains endemic in regions where sheep farming is common, particularly in our country, Tunisia. While it is a benign disease, its natural evolution can be marked by life-threatening complications. Cysto-biliary communication is the most common and serious complication. Spontaneous cutaneous fistulization is an extremely rare complication. We report the case of a 47-year-old female who presented with a chronic discharging sinus in the left upper quadrant of the abdomen. Clinical examination revealed a cutaneous opening with clear fluid discharge and surrounding inflammation. Abdominal imaging identified two hepatic hydatid cysts: one located in the left lobe, which was fistulized to the skin, and another in the right lobe. Surgical exploration confirmed the fistulous tract between the left hepatic cyst and the skin. A pericystectomy was performed on both cysts, along with excision of the fistulous tract. Cutaneous fistulization of a hepatic hydatid cyst is an infrequent complication, often resulting from chronic inflammation and gradual erosion of surrounding tissues. It may be misdiagnosed as a simple abscess, delaying appropriate treatment. Imaging techniques, particularly CT scans, are essential for diagnosis and surgical planning. Management relies on complete excision of the cyst and fistulous tract, combined with anti-parasitic therapy. Cutaneous fistulization of a hepatic hydatid cyst is a rare but serious complication that requires a high index of suspicion in endemic areas. Early imaging and prompt surgical intervention is essential to ensure complete recovery and prevent recurrence. • Cutaneous fistulization is an uncommon yet serious complication of hydatid disease • Establishing a preoperative diagnosis is particularly difficult in the absence of cystic material drainage from the external fistula tract. • Management involves surgical intervention, such as cystectomy or hepatectomy with excision of the fistulous tract, in combination with medical therapy. • Raising awareness is a key strategy in addressing hydatid disease and its complications.