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<p>Hepatic Alveolar Echinococcus (HAE) is a rare, life-threatening parasitic disease requiring aggressive surgical resection and long-term benzimidazole therapy. Until recently multilocularis had not been reported in India, but there are increasing reports of this condition from Kashmir. We report a rare case of HAE presenting as juxta-caval infiltrative space-occupying lesion (SOL) in the liver, mimicking a malignancy in a 46-year-old male with upper abdominal pain. The cross-sectional imaging demonstrated a SOL in liver segments VIII, IVa, and the caudate lobe, abutting the right hepatic vein (RHV) and left hepatic vein (LHV) and infiltrating the middle hepatic vein (MHV). Following a multidisciplinary discussion, the patient underwent complete resection of segments VIII, IVa, and the caudate lobe with excision of the infiltrated MHV through a superior aspect approach and without Pringle’s manoeuvre or any blood transfusions. The patient recovered uneventfully and was discharged on postoperative day five on a two-year course of albendazole. The histopathology showed laminated membrane with granulomatous reaction. This case demonstrates that radical resection, even when critically located, can be carried out by separating the hepatic veins by starting the parenchymal transection superiorly by judicious use of CUSA.</p>

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The Superior Aspect Approach in Parenchyma-Preserving Liver Resection for Alveolar Echinococcosis: Technical Strategy for a Rare Inter-hepatic juxtacaval Location

  • 期刊论文

  • 发表日期：

    2026年2月23日

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  • Sreekumar Sreejith,
  • Subhash Gupta,
  • Sushant Bhatia,
  • Jyoti Kharel,
  • Peush Sahni

摘要

Hepatic Alveolar Echinococcus (HAE) is a rare, life-threatening parasitic disease requiring aggressive surgical resection and long-term benzimidazole therapy. Until recently multilocularis had not been reported in India, but there are increasing reports of this condition from Kashmir. We report a rare case of HAE presenting as juxta-caval infiltrative space-occupying lesion (SOL) in the liver, mimicking a malignancy in a 46-year-old male with upper abdominal pain. The cross-sectional imaging demonstrated a SOL in liver segments VIII, IVa, and the caudate lobe, abutting the right hepatic vein (RHV) and left hepatic vein (LHV) and infiltrating the middle hepatic vein (MHV). Following a multidisciplinary discussion, the patient underwent complete resection of segments VIII, IVa, and the caudate lobe with excision of the infiltrated MHV through a superior aspect approach and without Pringle’s manoeuvre or any blood transfusions. The patient recovered uneventfully and was discharged on postoperative day five on a two-year course of albendazole. The histopathology showed laminated membrane with granulomatous reaction. This case demonstrates that radical resection, even when critically located, can be carried out by separating the hepatic veins by starting the parenchymal transection superiorly by judicious use of CUSA.