Asian Journal of Case Reports in Surgery

Aims: To describe a giant hepatic hydatid cyst presenting with chronic epigastric pain and to highlight the diagnostic importance of recognising nonspecific symptoms together with relevant occupational exposure.

Presentation of Case: A 34-year-old female sanitation worker from Leyte had a one-year history of intermittent epigastric pain that had initially been managed as gastro-oesophageal reflux disease, with only temporary symptomatic relief. She subsequently developed a progressively enlarging right upper quadrant mass. Computed tomography demonstrated a 15.5 × 15.1 × 18.1 cm cystic lesion arising from the right hepatic lobe, with an internal daughter cyst suggestive of hydatid disease. The patient received preoperative albendazole therapy for two months and subsequently underwent pericystectomy with controlled aspiration and use of a scolicidal agent. Histopathological examination demonstrated a thick acellular laminated membrane and residual germinal structures consistent with hydatid disease; no viable parasitic elements were identified. The postoperative course was uncomplicated, and the patient was discharged after three days.

Discussion: The case illustrates how hepatic hydatid disease may mimic common gastrointestinal disorders and remain unrecognised until substantial cyst enlargement occurs. Careful assessment of environmental and occupational exposure, together with appropriate imaging, can support timely diagnostic consideration and surgical planning.

Conclusion: Hepatic hydatid disease should remain a differential consideration in persistent epigastric symptoms accompanied by a hepatic mass and relevant exposure history.