Upper Gastrointestinal Bleeding Revealing a Hepatic Hydatid Cyst Complicated by Portal Hypertension Syndrome: A Case Report

Liver or Hepatic Hydatid Cyst (LHC/HHC) is a benign parasitic disease common in endemic regions such as the Mediterranean basin and North Africa, caused by Echinococcus granulosus. While hepatic hydatid cysts are prevalent, complications such as Portal Hypertension (PH) associated with this pathology are rare. We present the case of a 39-year-old male from a rural area and a chronic smoker, admitted for upper gastrointestinal bleeding. Clinical examination revealed cholestatic jaundice, massive splenomegaly and abdominal collateral venous circulation. Upper gastrointestinal endoscopy showed grade III esophageal varices, and abdominal ultrasound and CT scans confirmed the presence of a large hydatid cyst near the porto-biliary bifurcation, compressing intrahepatic vascular structures and causing portal vein dilation. Surgical management, including resection of the cyst’s protruding dome, was successfully performed, followed by Albendazole therapy to prevent parasitic dissemination. This multidisciplinary approach stabilized the patient’s condition, and complete resolution of esophageal varices after two endoscopic sessions of endoscopic ligation. A one-year follow-up demonstrated sustained clinical remission without recurrence. This case underscores the importance of early diagnosis and multidisciplinary management to prevent severe complications associated with portal hypertension secondary to a hepatic hydatid cyst.