Liver Augmentation and Surgical Management of Alveolar Echinococcosis: A Case Report

Introduction Alveolar echinococcosis (AE), caused by Echinococcus multilocularis, primarily affects the liver and grows slowly, often remaining asymptomatic. It behaves like a malignant tumor, invading surrounding tissues. Treatment typically involves combination of surgical resection and albendazole. This case highlights the challenges of managing AE while preserving liver function and liver volume [1,2]. Case Presentation A 68-year-old male patient presented to the hospital with dizziness and unexplained weight loss. Radiology and serology confirmed liver echinococcosis in segments S6/7/8 with hepatic vein involvement. Due to vascular involvement, surgery was initially not possible, and albendazole was administered at a dose of 400 mg twice a day. A few months later, the patient was re-evaluated. As cyst retreated from the middle hepatic vein and right hepatectomy was planned. However, liver scintigraphy revealed a functional capacity of 19% for the left hepatic lobe and 81% for the right hepatic lobe. To avoid post-hepatectomy liver failure (PVE), it was decided to augment the left hepatic lobe by embolizing the right branch of the portal vein. Two months later, scintigraphy was repeated, showing that the functional capacity of the left hepatic lobe had increased to 51%, while the right lobe's capacity was reduced to 49%. The patient successfully underwent resection of the right liver lobe. Histology confirmed the diagnosis of alveolar echinococcosis. Discussion AE is rare zoonotic disease with surgery as the only radical treatment; however, liver function must be evaluated beforehand, as post-hepatectomy liver failure remains a major complication. The standard of care is portal vein embolization (PVE), although about 20% of patients fail to undergo scheduled hepatectomy after PVE. In such cases segment 4 embolization, Associating Liver Partition and Portal vein Ligation for Staged hepatectomy (ALPPS) and hepatic vein embolization are potential salvage strategies [3,4]. Conclusions Surgery is the most effective treatment for alveolar echinococcosis [3]. However, when a large portion of the liver is damaged, liver augmentation may be necessary to ensure proper function. This case demonstrates the successful management of AE through surgical resection and liver augmentation.