Secondary peritoneal echinococcosis causing massive bilateral hydronephrosis and renal failure

A 64-year-old Moroccan man was referred to our clinic for abdominal cystic echinococcosis (CE). He had undergone surgery for hepatic CE 29 years earlier, with no perioperative prophylaxis with albendazole. He presented with abdominal distension and abdominal pain. An ultrasound (US) showed multiple CE3b and CE4 cysts with calcifications and two echo-free collections 13 cm in diameter seen on paraumbilical scans (Figure 1a). The portal tract, pancreas, spleen, kidneys, and aorta were not visible on US. The bladder was compressed by a large cyst. Serology for Echinococcus granulosus was positive (indirect hemagglutination test titer 1/4096; Echinococcus IgG ELISA optical density 6.70).