Staged surgical anesthesia in pediatric disseminated cystic echinococcosis: A case report

Background Cystic echinococcosis remains endemic in pastoral regions; however, evidence guiding perioperative anesthetic management in very young children with concomitant multi-organ (hepatic–pulmonary) involvement is limited. We report the anesthetic management of a 2-year-old girl with disseminated hepatic and bilateral pulmonary echinococcosis who underwent three staged operations within a short period, and we summarize practical perioperative considerations. Case presentation: The patient initially presented with abdominal distension and discomfort, followed by fever, productive cough, and hemoptysis. Imaging revealed multiple cystic hepatic lesions and multiple hydatid cysts in both lungs. A staged surgical strategy was adopted: open hepatic hydatid cystectomy with endocyst removal/pericyst management was performed first, followed by left and right thoracotomies for pulmonary hydatid cyst excision with closed thoracic drainage. Anesthetic management focused on dynamic evaluation of hepatic synthetic function and coagulation/albumin status, lung-protective ventilation under pediatric small-airway conditions, and protocolized preparedness for potential anaphylaxis associated with cyst fluid exposure. Pressure-controlled ventilation was used. Total intravenous anesthesia based on propofol was combined with a low concentration of inhalational anesthetic, remifentanil-based analgesia, and multimodal monitoring including arterial waveform analysis. No catastrophic events related to cyst rupture occurred; hemodynamics and ventilation remained stable throughout all procedures. Postoperative recovery was uneventful, and the patient was discharged on postoperative days 13, 29, and 8 after the three surgeries, respectively. Conclusions For pediatric patients with disseminated hepatic–pulmonary echinococcosis, staged surgery supported by iterative organ-function assessment, proactive anaphylaxis preparedness, and lung-protective ventilation may facilitate safe anesthetic care across multiple high-risk procedures. This case provides a transferable perioperative strategy for similar patients in endemic settings.