Hepatic echinococcosis is caused by the dog tapeworm Echinococcus granulosus. It is endemic in the Mediterranean region, Middle East, and South America. Sheep are the most common intermediate host. Human infection is secondary to accidental consumption of ova in feces. Absorption through the bowel wall and entrance into the portal circulation leads to infection of the liver.

This case involves a 34 year old Moroccan male with an echinococcal liver cyst. His chief complaint was RUQ pain. Patient failed medical therapy with albendazole and praziquantel. His PMH and PSH were non-contributory. He was taking no other medications and denied allergies to medications. ROS, other than pain, was unremarkable. 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.

Patient underwent successful laparoscopic drainage and excision of echinococcal cyst. Final pathology demonstrated degenerating parasites (E. granulosus) of echinococcal cyst.