Journal of Surgical Sciences Vol.7, No.4, October – December 2020 149 CLINCAL CASE HEPATIC HYDATID CYST RUPTURED INTRABILIARY IN A 28-YEAR- OLD HIV POSITIVE PATIENT Dan Nicolae Păduraru 1,2 , Georgiana Radu 1 , Daniel Ion 1,2 , Alina Tinca 1,2 , Bianca Smarandache 3 , Erika Oprea 2 , Gabriel Constantinescu 1,4 , Octavian Andronic 1,2 1 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 2 Bucharest University Emergency Hospital, Bucharest, Romania 3 ”Dr. Ion Cantacuzino” Clinical Hospital, Bucharest, Romania 4 Bucharest Emergency Hospital, Romania Corresponding author: Dan Nicolae Păduraru E-mail: dan.paduraru.nicolae@gmail.com Abstract Echinococcosis is an endemic disease in countries from the Mediterranean area, Eastern Europe, the Middle and the Far East, Australia, South America and Eastern Africa. However, it has a worldwide distribution because the dog, a definitive host, is a ubiquitous animal. Another important factor that led to a worldwide spread of the disease is population migration, as the number of cases in non- endemic regions has been increasing. We present the case of a 28-year-old HIV positive patient suffering from a liver hydatid cyst that had ruptured inside the biliary pathways. US and CT were the imaging tools used to establish a preoperatory diagnosis and the main therapeutic approach was neutralizing the parasite using 90⸰ alcohol, Lagot deroofing, contents’ evacuation through open surgery and appropriate drainage afterward. ERCP was very useful in unblocking the main biliary pathways after the surgery as well as installing a stent to ensure its further permeability. Keywords: hydatid disease, hepatic hydatid cyst, complicated hydatid disease, ruptured hydatid cyst Introduction Echinococcosis is an endemic disease in countries from the Mediterranean area, Eastern Europe, the Middle and the Far East, Australia, South America and Eastern Africa. However, it has a worldwide distribution because the dog, a definitive host, is a ubiquitous animal. Another important factor that led to a worldwide spread of the disease is population migration, as the number of cases in non-endemic regions has been increasing [1]. Biologically, E. Granulosus is a cestode species of the genus Echinococcus with only three stages of development. Its life cycle involves two mammalian hosts. The adult cestode will inhabit the intestine of a carnivore (considered a definitive host) while producing eggs that contain infective oncospheres. Through the intestines of the definitive host, either cestode segments containing eggs or free eggs will be released into the environment. These eggs are found and ingested by an intermediate host animal. The eggs open inside the digestive tract of the intermediate host, thus releasing the metacestode, a larval stage. Typically, the mature metacestode can produce numerous protoscoleces. Each one of these protoscoleces has the potential to develop into an adult parasite