Necrotizing fasciitis of the abdominal wall revealing a delayed hepatic hydatid fistula: A rare and severe late complication

Abstract

Hydatid liver disease is endemic in many regions and, though often curable with surgery, can lead to rare long-term complications. We report a 57-year-old woman with a history of hydatid cyst excision and cholecystectomy 40 years prior, presenting with right hypochondrial parietal gangrene and fever. Imaging revealed hepatic subcapsular collections fistulizing into the abdominal wall, complicated by necrotizing fasciitis. Emergency debridement and drainage were performed, followed by broad-spectrum antibiotics. ERCP with sphincterotomy was later performed to remove bile duct stones. This case highlights a rare and severe late complication of hydatid liver surgery. The delayed fistulization and secondary infection emphasize the need to consider remote surgical history in atypical soft tissue infections. Necrotizing fasciitis due to a delayed hepatic hydatid fistula is exceptional. Early recognition, imaging, surgical intervention, and multidisciplinary care are vital for favorable outcomes. • Delayed hepatic hydatid fistula can manifest decades after surgery with life-threatening complications. • Abdominal wall necrotizing fasciitis may reveal hidden hepatobiliary pathology. • A staged management combining emergency debridement and delayed ERCP ensures better outcomes in complex hydatid disease sequelae.