Multiple Giant Liver Cysts in a Nepalese Lad
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An 8-year-old boy from rural Nepal presented with progressive fullness and pain over the upper abdomen for a year without associated fever, jaundice, vomiting, or bowel complaints. There was no preceding history of trauma or weight loss. Physical examination revealed massive hepatomegaly, and ultrasonography showed 3 giant (greater than 10 cm) cysts involving both the liver lobes.

Blood investigations were unremarkable, and echinococcal ELISA was negative. Abdominal CT scan confirmed multiple cysts in hepatic segments 2, 3, 6, and 7 with features favoring echinococcal etiology. Following 3 weeks of oral albendazole therapy (10 mg/kg/day BD), he underwent laparotomy with cyst aspiration which revealed clear fluid from the 2 subphrenic cysts and bile-stained aspirates from the cyst over the under surface of the liver, cytology of which showed free hooklets. Following this, instillation of the scolicidal agent (hypertonic saline) was done for 20 minutes, followed by reaspiration. Following this, partial pericystectomy with capitonnage and omentoplasty was done for cavity obliteration.

He had an uneventful postoperative recovery. The subhepatic and left subphrenic drains were removed on day 3 and day 4, respectively, and he was discharged on day 5. At 2-week follow-up, his symptoms had improved, and he was advised to continue 2 further cycles of oral albendazole. At follow-up, a year later, he remained symptom-free.

When dealing with multiple liver cysts in children consideration for echinococcal etiology becomes important in endemic areas. Larger cysts require surgical ablation in general combined with antihelmithics. The preferred surgical approach depends upon the cyst dimension, location, and anticipated intraoperative events or complications.