Surgical treatment of complicated ductus choledochus hydatidosis during the COVID-19 pandemic: Effectiveness and limitations of radiological services and surgery in extraordinary conditions

Abstract

Introduction: While uncomplicated echi-nococcal cysts can grow in the liver for years without symptoms, complicated hydatid cysts (CHC) present distinct clinical characteristics that necessitate urgent treatment. Case Report: We present a case of acute biliary obstruction, cholangitis, and sepsis due to massive cho-ledocho-hydatididosis in an 84-year-old COVID-positive patient during the COVID-19 pandemic. Imaging revealed a multicystic lesion in liver segments V and VIII that compressed surrounding liver tissue, leading to intrahepatic duct dilation. A daughter cyst in the ductus choledochus was confirmed during surgery. An attempt at endoscopic retrograde cholangiopancrea-tography (ERCP) was unsuccessful. We performed an open pericystectomy with total cystectomy and choled-ochotomy, carefully evacuating all hydatid cysts. The postoperative course was uneventful, and the patient was discharged without surgical complications. Conclusion: Complicated hydatid cysts (CHC) leading to acute biliary obstruction require prompt diagnosis and indicate the need for rapid evacuation of the cyst and correction of complications.