Abdominal effusion revealing an exophytic hydatid cyst of the liver has developed under mesocolic

The hydatid cyst of the liver is a parasitic disease due to the development of echinococcosis granulosus. It is common in livestock regions in developing countries but is gaining interest in the West due to migratory flows. If it remains a benign and asymptomatic affection for a long time, its natural evolution is often enamelled of complication which can put at the risk of vital prognosis. Diagnosis and staging are based on morphological examinations, including ultrasound and CT scan. The hydatid serology retains a place especially for the detection of recurrence after hydatid cyst of the liver surgery. In addition to surgery considered up to as the radical treatment of choice, other techniques have appeared in the therapeutic arsenal in combination with oral treatment with albendazol for uncomplicated cases thus reducing the morbidity of surgery. We report a case of giant hydatid cyst associated with exophytic liver development under mesocolic associated with a peritoneal hydatidosis.


Introduction
The hydatic cyst of the liver generates various pathological lesions responsible for various polymorphic clinical pictures; its treatment aims to eliminate the parasite, and to solve the problem of the residual cavity and any associated complications. The therapeutic methods are numerous [1], medical and surgical, by classical or laparoscopic way, but none can be erected in standard gold because of the diversity of the anatomopathological lesions. A hydatid cyst of the liver is a benign parasitic tumor affecting both sexes and all ages, the choice of a method in the therapeutic arsenal available should allow healing with almost no mortality and the lowest possible morbidity, avoiding the risk of recurrence.

Patient and observation
This is a 57-year-old patient with no notable pathological history, originally from rural areas. He presented for 12  China [2]. It affects both sexes with a female predominance [3].
Factors favoring Echinococcus granulosus infestation are occupations exposed to contact with livestock and dogs, uncontrolled slaughter and defective hand and food hygiene [3].

Positive diagnosis
Clinic: circumstances of discovery are very diverse, dominated by: pain of the right hypochondrium, right basithoracic, right lumbar or epigastric. Fortuitly during a consultation for other affection, examination of employment, the balance of extension for other localization. Clinically: the abdominal inspection is most often normal.
Sometimes there is a curvature of the right hypochondrium. Palpation and percussion seek hepatomegaly: it is inconstant. The hydatid cyst of the liver is sometimes seen as a rounded or oval mass, well limited, firm or renitant, painless, mobile with the liver when breathing.

Paraclinic
Abdominal ultrasound: as a key diagnostic test in view of its availability and reliability [4], it makes it possible to specify the headquarters, the size, the reports and the starification of Gharbi. The classification of Gharbi [5] was the first and most commonly used classification (Table 1). This classification is now increasingly being replaced by that developed by the informal working group on echinococcosis of the World Health Organization. Health (WHO) [2] ( Table 2). It is distinguished from the by introducing the notion of "cysticlesion" which is a unilocular lesion, small (often less than 0.5 cm) without its own wall visible and inverting types II and III of both classifications [6] Table 3.
Abdominal tomography: CT is useful when the diagnosis is difficult (Gharbi type I, IV and V) by eliminating differential diagnoses, namely: a biliary cyst, a hepatic angioma, an adenoma, a hepatocarcinoma, a liver abscess or a hepatic metastasis in its cystic form. Computed tomography is also indicated in case of multiple hydatid localization, complicated hydatid cyst of the liver or in case of hydatid recurrence [7].

Non-operative treatment
Medical treatment: oral antihelminthics have a direct effect on scolex and perhaps also on the membrane with reduced permeability [9]. Albendazole (ABZ) is the most commonly used. The combination ABZ-praziquantel would be more effective than the ABZ alone [10]. ABZ is prescribed at a dose of 10 to 15 mg/kg/day in two doses taken orally. Treatment is continuous for 3 to 6 months [11].
Efficacy is monitored on ultrasound, which seeks a decrease in the volume of hydatid cyst of the liver or an increase in the echogenicity of its contents [12]. When ABZ is prescribed in combination with another procedure, it is given 4 days to 1 month before surgery or percutaneous puncture, then 3 months after [9].  [5]. ABZ is prescribed per os before and after the procedure [9]. It is indicated for inoperable patients and those who refuse surgery or in case of hydatid recurrence after surgical treatment [2].

Surgical treatment
Which way first? the classical approach is a right subcostal laparotomy that can be enlarged on the left for cysts of the left liver

Conclusion
The hydatid cyst of the liver is a parasitic condition that can remain latent for a long time. The treatment of hydatid cyst of the liver is mainly surgical. However, it remains difficult to codify because of the

Competing interests
The authors declare no competing interests.

Authors' contributions
All the authors have read and agreed to the final manuscript.        Rounded formation hypo-echoic multi-partitioned in "honeycomb". This type corresponds to the multi-vesicular cyst.

type IV
Heterogeneous round formation of pseudo-tumoral appearance. It is very suggestive of hydatid cyst of the liver when it contains serpiginous, "draped" or "bulbous onion" images (corresponding to collapsed vesicles and membranes), or when it also includes small formations hypo-echogenic (corresponding to girls' vesicles). This type corresponds to a cyst with gelatinous content or putty. type V Rounded formation with a hyperechoic wall with posterior shadow cone. This type corresponds to a cyst whose percyyst is calcified Univésiculaire, simple cyst with uniform anechoic content. Cyst can be à fine echo of the movement of the capsule brood which is often called hydatid sand ('snowflake sign') Wall of the visible cyst CE2 Multivesicular, multicleaned cysts, septa Ons of the cyst produce a 'wheel + like' structure, and the presence of daughter vesicles is indicated by 'rosette' or 'nidd'abeille' structures. The daughter vesicles may partially or completely occupy the vesicle of the mother cyst. Normally visible cyst wall CE3 Univésiculaire cyst which can contain girls vesicles. Anechoic content with detachment of a laminated membrane from the visible cyst wall as a floating membrane or as a 'water + lily sign' which is indicative of floating membranes above debris of cystic fluid. CE4 Degenerative, heterogeneous, hypoechoic or hyperechoic content. No blisters girls. Can show a 'wool ball' sign that indicates degenerative membranes CE5 Cysts characterized by a calcified thick wall that is arc-shaped, producing a shadow cone. Degree of calcification varies from partial to complete CL = Cystic lesion -CE = Cystic Echiniccocus or hydatid cyst