The psoas muscle localization is even more exceptional when they are multiple. The clinical and radiological features were often misleading. This case report aimed to highlight the difficulties of radiological diagnosis and the dilemma of choosing the best operative approach. A 27 year-old-men with no past medical history has been consulted for right down abdominal quadrant pain. Physical examination revealed a painless abdominal mass. An abdominal CT Scan concluded with the presence of two multisectional cystic lesions. The first cystic lesion had an exophytic development, and the second cystic lesion was in the posterior and lateral sides of the psoas muscle. The hemaglutinin reaction and the Western blot were positive. A laparotomy was done. The exploration objective is a first psoas muscle hydatid cyst of 5 cm with an exophytic development just behind the vermiform appendix with a second hydatid cyst of 15 cm. The puncturing and aspiration of the cystic fluid bring a clear hydatid fluid. Parasitic sterilization was performed by injecting a scoliosis solution, hypertonic serum, into the cystic lesion. After ten minutes, we resected the two cystic lesions' protruding dome. We have aspirated the fluid and all the daughter hydatid cysts from the two hydatid cysts. The postoperative follow-up was uneventful. The primary hydatid cyst of the psoas muscle often causes a problem of its hydatid nature. Surgery remains the only curative treatment. It avoids the risk of complications such as peritoneal rupture, which can modify the surgical therapeutic strategy.