Background Hydatid cyst disease is amongst the most common zoonotic parasitic manifestations, caused by Echinococcus granulosus where humans act as an accidental host. Hydatid cyst of anterior wall (1-4%) has been observed in a few patients without primary involvement of the liver.

Case Presentation A 33 year old, young male presented with on and off dull aching abdominal pain with fever for 5 years but was misdiagnosed as anterior abdominal wall haematoma. The only significant history was possession of an unvaccinated stray dog. Physical examination revealed a cystic, tender swelling around 5x10 cm in the region of right hypochondrium to right lumbar region. Abdominal Contrast enhanced computed tomography revealed a slightly thick walled cystic appearing lesion 6.1x 9.6 x 5.5 cm suggesting a focal discontinuity of its antero-medial wall with surrounding relatively ill- defined hypo-dense collection seen partly insulating in the inter-muscular planes, suggesting a partly ruptured hydatid cyst without any evidence of any intraperitoneal extension. Serology of Hydatid cyst was positive. Patient was prophylactically started on Albendazole until surgical exploration. During surgery, cystic mass was found adherent to anterior abdominal wall muscles without any parietal peritoneum adhesions. En-masse excision was done from subcutaneous planes, keeping the cyst wall intact. The point of rupture was identified and the cyst fluid and daughter cysts suctioned with minimal spill to vicinity and irrigation was performed with hypertonic saline. Cetrimide soaked gauze was placed at operative site for 10 minutes. Gross and Histopathology examination confirmed Hydatid cyst. Patient was advised to take oral Albendazole and Praziquantel for 6 months. Patient had an uneventful post-operative course till 6 months follow up.

Discussion Echinococcus granulosus, the smallest of all tapeworms, a zoonotic cestode with humans being an accidental host infected by ingestion or direct contact with infected canines. The clinical course and symptoms of cystic hydatidosis depend upon site of infection, size of cysts and the pressure symptoms caused by enlargement of the cysts. Careful history taking, thorough examination along with the use of radiological and serological investigations aid in reaching a confirmatory diagnosis of the disease. Treatment modalities comprise of anti- parasitic drugs, PAIR (puncture-aspirate-inject- reaspirate) and surgery. Prevention of cystic echinococcosis includes public education, deworming of dogs and slaughter house hygiene. Early and prompt diagnosis with timely management is the need of the hour to decrease the global burden of the disease.