Anaesthetic management of infected hepatic hydatid cyst in a patient with pulmonary hypertension and heart failure with preserved ejection fraction: A case report

Abstract

Hydatid disease complicated by secondary infection poses significant perioperative challenges, particularly in patients with multiple comorbidities such as heart failure with preserved ejection fraction (HFpEF) and chronic liver dysfunction. We report the anaesthetic management of a 68-year-old female with residual infected hydatid cysts following prior biliary instrumentation and drainage procedures, undergoing open surgical excision. A combined thoracic epidural and bilateral external oblique intercostal block (EOIB) technique was employed alongside balanced general anaesthesia to optimise analgesia, minimise opioid use, and support haemodynamic stability. This multimodal approach facilitated uneventful intraoperative and early postoperative recovery without respiratory compromise or anaphylaxis. The case highlights the importance of tailored anaesthetic planning, preparedness for cyst rupture-related complications, and the analgesic benefits of integrating EOIB into the perioperative regimen for complex upper abdominal surgeries.