Hydatid cyst of the pancreas revealed by acute pancreatitis: A case report

Abstract

Introduction and importance: A hydatid cyst is a parasitic disease caused by the development of the larval form of Echinococcus granulosus (1). The liver and lungs are the most frequent locations, while pancreatic involvement is unusual (<1 %), even in countries where hydatid disease is endemic (2). We report a rare case of a hydatid cyst of the pancreas, revealed by acute pancreatitis. Through this observation and a review of the literature, we discuss the diagnostic and therapeutic challenges of this rare localization of a hydatid cyst.

Case presentation: A 60-year-old man from rural southwestern Tunisia, with a medical history of cardiac conduction disorder such as atrioventricular block treated with a pacemaker and type II diabetes for 10 years, presented with epigastric pain and periodic episodes of vomiting for the past 2 years. The patient noticed a recent exacerbation of the pain over the last 3 months. On physical examination, there was no jaundice or fever. Mild tenderness of the entire supramesocolic region of the abdomen was revealed, and no palpable mass was evident. Biological tests showed an elevation of lipase to 5 times the normal level and an increased leukocyte count of 12,000/dL. Liver function tests were normal. The CT scan indicated pancreatitis, Balthazar grade E, with cystic formation in the tail of the pancreas extending into the dilated Wirsung duct. The echinococcal immunological test (ELISA) was positive, and tumor markers (CEA, CA 19-9) were negative. The diagnosis of a pancreatic hydatid cyst with pancreatitis was considered. The patient underwent surgery 2 months after the onset of pancreatitis. A left splenopancreatectomy was performed. Histopathological examination confirmed the presence of a hydatid cyst. Following an uneventful postoperative period, the patient was discharged on the 7th postoperative day. The patient was treated with Penicillin V (Oracillin®) 2 million IU per day for 2 years and Albendazole 800 mg per day for 2 months after surgery. At 1 year post-surgery, no hydatid recurrence was detected, and hydatid serology was negative.

Clinical discussion: Finally, We reported the case of a rare observation of hydatid cyst of the pancreas revealed by acute pancreatitis.

Conclusion: We highlighted the necessity to consider the hydatid origin when evaluating complicated cystic pancreatic tumors, especially in endemic regions.

Keywords: Echinococcosis; Hydatid cyst; Pancreas; Surgery.