Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2011, Article ID 107087, 6 pages doi:10.1155/2011/107087 Case Report Laparoscopic Drainage of a Hepatic Echinococcal Cyst: A Case Report Steven B. Goldin, James J. L. Mateka, Michael J. Schnaus, and Sujat Dahal Department of Surgery, College of Medicine, University of South Florida, Tampa, FL 33606, USA Correspondence should be addressed to Steven B. Goldin, sgoldin@health.usf.edu and James J. L. Mateka, jmateka@health.usf.edu Received 2 June 2011; Accepted 26 June 2011 Academic Editors: G. Nardone and I. Siddique Copyright © 2011 Steven B. Goldin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Echinococcus granulosus tapeworm causes hepatic echinococcosis. It is endemic in the Mediterranean region, Middle East, and South America. Human infection is secondary to accidental consumption of ova in feces. Absorption through the bowel wall and entrance into the portal circulation leads to liver infection. This case involves a 34 y/o Moroccan male with an echinococcal liver cyst. His chief complaint was RUQ pain. The patient was treated with albendazole and praziquantel. His PMH and PSH was noncontributory. Patient was not on any other medications. ROS was otherwise unremarkable. The patient was AF VSS. He was tender to palpation in RUQ. Liver function tests were normal. Echinococcal titers were positive. CT demonstrated a large cystic lesion in the right lobe of the liver measuring 13.5 cm in diameter. The patient underwent successful laparoscopic drainage and excision of echinococcal cyst. Final pathology demonstrated degenerating parasites (E. granulosus) of echinococcal cyst. 1. Introduction Hepatic echinococcus is acquired by humans secondary to accidental consumption of ova in dog feces [1]. It results from infection by the dog tapeworm. It is endemic in sheep and cattle raising areas in Europe, China, Russia, the Mediterranean region, Middle East, South America, Aus- tralia, New Zealand, and Southern Africa. It is exceedingly rare in the United States [2] and mainly occurs in members of high risk groups such as sheep farmers in the west, some native American Indians in the southwest and Alaska, and in immigrants [3]. Its incidence is estimated to be less than 1 case per 1 million population in the continental United States and can range from 1 to 220 cases per 100,000 persons in endemic areas. Hepatic echinococcal cysts are described most frequently using the ultrasonographic classiﬁcation system of Gharbi et al. [4] (Table 1). Based on the Gharbi classiﬁcation system, the World Health Organi- zation (WHO) Informal Working Group on Echinococcosis modiﬁed their International Classiﬁcation System [5] to identify the functional state of parasites to deﬁne treatment (Table 2). 2. Case Report A 34-year-old Moroccan male presented with a several month history of moderately severe, constant, and progres- sively worsening, dull aching right upper quadrant pain (RUQ). There were no alleviating and precipitating factors. A computed tomography (CT) scan revealed a 13.5 cm cystic lesion in the right lobe of the liver (Gharbi Type I) and densely calciﬁed masses in the right and left sides of the liver (Gharbi Type V). An ELISA test for echinococcal infection was positive. The patient was treated with albendazole and praziquantel for 3 months with no clinical or radiographic improvement (Figure 1). Laparoscopic cyst evacuation and partial cyst excision was undertaken. The procedure was done using four 12 mm ports as shown in Figure 2. The cyst was ﬁrst surrounded with pads soaked in a scolicidal agent (20% hypertonic saline) (Figure 3), to protect the abdominal contents from contam- ination. Approximately, 400 mL was aspirated from the cyst, which was then ﬁlled with 1 liter of 20% hypertonic saline (Figure 4). This saline was aspirated, and the cyst reﬁlled again with hypertonic saline. The saline was allowed to dwell