Intraportal Rupture of a Hepatic Hydatid Cyst Complicated by Arterioportal Fistula and Hepatic Artery Pseudoaneurysm

A 71-year-old woman with known hepatic hydatid disease presented with fever, abdominal pain, vomiting, and jaundice.Magnetic resonance imaging (MRI) with MR cholangiopancreatography revealed rupture of a right hepatic hydatid cyst with intraportal hydatid dissemination associated with a hepatic artery pseudoaneurysm and an arterioportal fistula.The patient rapidly developed severe acute cholangitis with multiorgan failure.Endoscopic retrograde cholangiopancreatography (ERCP) allowed extraction of the hydatid material and biliary stenting, followed by selective endovascular embolization of the hepatic artery pseudoaneurysm.Despite combined endoscopic and interventional management, the patient progressed to refractory multiorgan failure and died.The present case illustrates a rare and life-threatening vascular complication of hepatic hydatid disease, emphasizing the importance of early imaging diagnosis and multidisciplinary management.In the present case, simultaneous portal and arterial involvement was associated with an unfavorable outcome.