When Silence Speaks: A Perforated Hepatic Cyst, Intact Omental Cyst, and Cholelithiasis

A 39-year-old man from an echinococcosis-endemic region presented with acute left upper quadrant pain. Imaging revealed cholelithiasis, a hepatic and a large abdominal cystic masses, and significant free peritoneal fluid. Urgent laparotomy unexpectedly disclosed three concurrent pathologies: chronic calculous cholecystitis, a perforated hepatic hydatid cyst, and an intact omental hydatid cyst. The exact source of his symptoms remains uncertain. This case highlighted the diagnostic challenge of coexisting surgical diseases in endemic regions.