A 28-year-old shepherd from a sheep-rearing region has a solitary 6 cm right lobe liver cyst. Ultrasound shows a well-defined unilocular anechoic cyst with detached floating endocyst membranes (water lily appearance absent, no daughter cysts), classified as WHO-IWGE stage CE1. He is otherwise asymptomatic. The most appropriate management is:
- A Observation with serial ultrasound alone
- B Open cystopericystectomy with omentoplasty
- C Albendazole therapy followed by percutaneous puncture, aspiration, injection and re-aspiration (PAIR) ✓
- D Laparoscopic total pericystectomy
Correct answer: C. Albendazole therapy followed by percutaneous puncture, aspiration, injection and re-aspiration (PAIR)
Explanation
WHO-IWGE stage CE1 is an active, fertile unilocular cyst, and the recommended first-line approach for such cysts is albendazole cover followed by PAIR, which carries lower morbidity than surgery for uncomplicated CE1 lesions. Observation alone applies to inactive stages CE4 and CE5, which this cyst is not, since daughter cysts and detached membranes are absent. Surgery is preferred over PAIR for multivesicular CE2 and solid-cystic CE3b disease, for cysts communicating with the biliary tree, and for inaccessible locations.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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