Laparoscopic management of a ruptured hepatic hydatid cyst with a cystobiliary fistula in an adolescent: a case report

Introduction and importance: Ruptured hepatic hydatid cysts are uncommon but potentially life-threatening, especially in adolescents. Acute rupture may present with severe abdominal pain, peritonitis, or sepsis and requires prompt diagnosis and timely surgical intervention. Laparoscopic management has emerged as a safe and effective approach, even in complicated presentations. Case presentation: A 16-year-old girl presented with a 1-week history of abdominal pain that had worsened over 2 days, accompanied by nausea, vomiting, and a low-grade fever. Examination revealed generalized abdominal tenderness, guarding, and rigidity. Laboratory tests showed leukocytosis and elevated C-reactive protein, with normal liver and renal function. Ultrasound and contrast-enhanced computed tomography identified a giant ruptured right hepatic hydatid cyst (15 × 13 cm) with perihepatic fluid and daughter cysts. Emergency laparoscopy using a three-port technique was performed. Partial pericystectomy and 20% hypertonic saline irrigation were completed without spillage. A cystobiliary fistula was identified and closed laparoscopically. A drain was placed. The postoperative course was uneventful, and at the 6-month follow-up, the patient remained asymptomatic. However, longer follow-up is needed to confirm long-term outcomes. Clinical discussion: Rupture of hepatic hydatid cysts is a serious complication associated with significant morbidity and a risk of recurrence. Laparoscopic surgery allows excellent visualization, effective peritoneal lavage, safe management of cystobiliary fistulas, and reduced postoperative pain and hospitalization. Avoiding spillage is essential to prevent secondary implantation. Adjunct albendazole therapy is recommended to reduce the risk of recurrence. This case is notable for emergency laparoscopic repair in an adolescent with a cystobiliary fistula, a rare presentation in pediatric literature. Conclusion: Laparoscopic management of ruptured hepatic hydatid cysts with cystobiliary fistula in adolescents is safe, feasible, and effective, provided meticulous surgical technique and structured postoperative care are applied.