A 30-year-old shepherd from a sheep-rearing region has a 6 cm unilocular hepatic cyst with a double-layered wall and floating membranes on ultrasound. Serology for Echinococcus granulosus is positive. After starting albendazole, the most appropriate definitive treatment is:

• A PAIR: puncture, aspiration, injection of scolicidal agent, reaspiration ✓
• B Observation with albendazole alone
• C Total pericystectomy
• D Liver transplantation

Explanation

This is WHO stage CE1 active hydatid disease. Albendazole followed by PAIR is recommended for uncomplicated CE1 and CE3a cysts larger than 5 cm, with excellent results and low morbidity. Albendazole alone rarely sterilizes large active cysts, so observation is inadequate. Pericystectomy gives the lowest recurrence but is major surgery reserved for complicated, giant, biliary-communicating, or inaccessible cysts, and transplantation has no role in echinococcal disease.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.