A periaortic hydatid cyst revealed by anaphylactic shock

A 66-year-old man operated on for hepatic echinococcosis 10 years earlier and receiving conservative surgery, presented to the emergency department with unconsciousness, respiratory distress, and a systemic rash. He was diagnosed with anaphylactic shock and successfully resuscitated. Abdominal computed tomography showed a 9-cm cyst surrounding and compressing the aorta and the iliac bifurcation (Figure 1), which was confirmed to be a multivesicular hydatid cyst by magnetic resonance imaging (Figure 2). The Gharbi classification based on ultrasound could not be determined without echography. Through a transperitoneal approach, the cyst was found extending below the renal arteries to the aortic bifurcation. The cystic cavity was filled with a hypertonic solution. The cyst comprised a cuticular membrane and multiple daughter cysts. Due to aortic adherence, a partial cystectomy was performed (Figure 3). The postoperative course was uneventful and the patient was discharged one week later. Computed tomography one year later showed no signs of recurrence.