Figure - uploaded by Zoubeir Ben Safta
Content may be subject to copyright.
Abdominal CT-scan shows a pancreatic cystic mass of 10 cm, with a clean and calcified wall and containing daughter cysts (one arrow). The main pancreatic duct is dilated (two arrows). Between the main pancreatic duct and the cyst, abdominal CT-scan shows a detachement of the hydatid membrane in the pancreatic cyst (dotted arrow).
Source publication
Hydatid disease is a major health problem worldwide. Primary hydatid disease of the pancreas is very rare and acute pancreatitis secondary to hydatid cyst has rarely been reported. We report the case of a 38-year-old man who presented acute pancreatitis. A diagnosis of hydatid cyst of the pancreas, measuring 10 cm, was established by abdominal comp...
Context in source publication
Context 1
... CT-scan showed also daughter cysts, some peripheral cal- cifications and a detachment of the hydatid membrane in the pancreatic cyst. This is evidenced by a pressure drop inside the cyst and thus, an opening of the cyst in the pan- creatic duct which is dilated (Figure 1). Nothing was detected in the liver or in any other organs. ...Similar publications
Intraductal tubulopapillary neoplasm (ITPN) of the pancreas has been recently reported. It is very rare, therefore clinical behavior and prognosis has not yet been characterized. We experienced a case of ITPN of the pancreas which presented with acute pancreatitis and treated with Whipple's operation. Histopathologic finding showed papillary hyperp...
Citations
... tissue while bypassing the liver by means of pancreatic veins. The 5th and last theoretical pathway is in the form of retroperitoneal dissemination [6,[17][18][19][20][21][22][23]. ...
... Historical accounts from a 2012 review [19] reveal that in 90 % of cases, the cyst exists as a solitary entity within the pancreas. Furthermore, (50 %) of these cysts are predominantly positioned in the pancreatic head, with (24-34 %) were found the pancreatic body and (16-19 %) were documented in the pancreatic tail. ...
... Acute pancreatitis is a rare clinical manifestation but can nonetheless transpire due to obstruction of the pancreatic duct by outside compression result from the cyst or internal blocking by scolices in case they established cystductal communication. Rarer complications entail necrotizing pancreatitis, sinistral portal hypertension especially with lesions situation in the tail of the pancreas, and repeated episodes of pancreatitis [19,26]. ...
Introduction and importance
Primary pancreatic hydatid cysts are exceptionally rare as they have an incidence rate ranging from 0.14 % to 2 %. Due to their extreme rarity, the patient's clinical manifestations are nonspecific. This leads to misdiagnosis and delay in treatment. Therefore, a multidisciplinary approach is necessary for the proper treatment of this pathology.
Case presentation
Herewith, we present the rare case of a 46-year-old Middle Eastern female who sought medical attention at our surgical clinic complaining of an acute on-top-of chronic epigastric pain that radiated to the back. It was associated with a reported dark and pale discoloration of the urine and stool, respectively. The preoperative investigative radiological analysis identified a primary pancreatic body mass formation.
Clinical discussion
A meticulous surgical resection of the pancreatic body, tail, and the spleen was performed. Subsequent histopathological analysis of the excised specimens decisively established the diagnosis of a primary pancreatic body hydatid cyst.
Conclusion
Primary pancreatic hydatid cysts are profoundly rare, and their occurrence in the pancreatic body is even rarer. The profound scarcity of published literature on primary pancreatic body hydatid cysts highlights the imperative need for documentation, epidemiological studies, and the development of crucial interventional protocols. After a meticulous review of the published literature, we deduced that ours is the third documented case from our country of a primary pancreatic body hydatid cyst. Furthermore, no other cases beyond these three have been published from our country involving primary pancreatic hydatid cysts.
... Hydatid disease can involve with many organ but effects liver in 70% of patients and lungs in 20% of patients. This disease also effects muscles, bones, brain and spleen (1,3). This disease primarily involves pancreas very rarely and in literature 0.2-2% of all hydatid diseases were reported as primary pancreatic hydatid disease (4,5). ...
... Primary involvement of pancreas with hydatid disease is an unexpected diagnosis for most physicians. Primary pancreatic hydatid cysts are mostly seen in the head (57%), body (24%) and tail (19%) (1)(2)(3)6). In this case hydatid cyst was located in the tail and it replaced pancreatic tissue. ...
... Clinical presentation can be different from each other based on size and location of hydatid cyst inside of the pancreas in addition to pancreatic canal involvement (1)(2)(3)(6)(7)(8). Cysts that located in the head of pancreas may cause jaundice, cholangitis and pancreatitis but cysts are located in body and tail may be more silent and they can grow slowly until they cause symptoms (fullness, early satiety, abdominal discomfort and pain) or complications (6,7). ...
Hydatid disease is a zoonotic parasitic disease which rarely involves pancreas primarily. Diagnosis of pancreatic hydatid cyst is a challenge and operative skills are important to avoid spillage of cyst’s content. A 19-year-old male patient was admitted to hospital with recurrent abdominal pain which was on epigastrium and left upper quadrant of abdomen. Pain was not associated with nausea, vomiting or fever. An abdominal computed tomography (CT) scan was ordered. As a result of abdominal CT scan, there was a cystic area in tail of pancreas with a diameter of 5.6 cm which includes septa and there was calcification on borders of the cyst. Possible diagnosis were either pancreatic hydatid disease, pancreatic cyst adenoma or cystadenocarcinoma or pseudocyst of autoimmune pancreatitis. Whole body positron emission tomography (PET-CT) scan showed no other cyst or lesion other than pancreatic cyst. Hydatid disease indirect hemagglutination test has been studied and it was positive. Imaging studies and laboratory results were suggested hydatid disease and laparoscopic distal pancreatectomy has been applied. Primary pancreatic hydatid disease should be in differential diagnosis when newly appearing pancreatic cyst has been diagnosed, especially in endemic areas. Appropriate surgical technique has to be applied to avoid dissemination of cyst’s content.
... About 50-57% of the cases, 24-34% of the cases, and 16-19% of the cases, respectively, have the pancreatic hydatid cysts positioned in the head of the pancreas, the corpus of the pancreas, and the tail of the pancreas. 3 The majority of instances of pancreatic hydatid cyst are characterized by the presence of a single lesion. ...
Hydatid cysts of the pancreas are quite uncommon. Even more uncommon are pancreatic hydatid cysts associated with portal hypertension. The illness may manifest either simultaneously with systemic involvement or as an isolated pancreatic involvement. Both of these scenarios are possible. We provide the first instance of a patient who had a laparoscopic distal pancreatectomy for treatment of a pancreatic hydatid cyst associated with lateral portal hypertension. There were neither complications nor recurrences of the condition. A male patient of 25 years old was brought into our facility complaining of epigastric and back discomfort. The patient's upper abdominal contrast enhanced computed tomography showed a unilocular cystic lesion (10 cm × 9 cm × 7 cm) in the tail of the pancreas, coupled with several collaterals at the splenic hilum, along the greater curvature of the stomach, and at the pylorus. He had a laparoscopic procedure of distal pancreatectomy, along with a splenectomy. His recovery from surgery went well, and a histological analysis revealed a hydatid cyst in both the pancreatic tail and body.
... Pancreatic hydatid cysts are an exceptional form of hydatid disease, and isolated involvement has rarely been reported [1] . This explains the diagnostic difficulty of this entity. ...
... However, the pancreatic location has a prevalence of less than 1% [2] . It is isolated in 90% of cases with a predilection for the cephalic part of the pancreas (57%) [1] . Humans are accidental hosts, as infection occurs by ingesting food contaminated with Echinococcus eggs. ...
Hydatid disease is a worldwide public health problem, especially in endemic countries, caused by the larval stage of Echinococcus granulosis. The pancreatic location of this disease is exceptional, representing only 1% of all possible locations, making this a widely misdiagnosed entity. We report a case of a 42-year-old man with a history of alcoholism and recurring abdominal pain, who presented to the emergency department with acute pancreatitis revealing a hydatid pancreatic cyst mimicking as a pseudocyst of the pancreas. The diagnosis was established using computed tomography and magnetic resonance imaging.
... All data for the clinical symptoms of cystic echinococcosis of the pancreas come from a small published series or case reports in the literature. An abdominal mass, epigastric pain, weight loss, discomfort, and vomiting are the main nonspecific clinical symptoms [5,9,10,[14][15][16][17][18][19][20][21][22]. PCE located in the pancreatic head most commonly causes cholangitis, obstructive jaundice, or acute pancreatitis [3,12,13,16,[21][22][23][24][25][26][27][28]. ...
... An abdominal mass, epigastric pain, weight loss, discomfort, and vomiting are the main nonspecific clinical symptoms [5,9,10,[14][15][16][17][18][19][20][21][22]. PCE located in the pancreatic head most commonly causes cholangitis, obstructive jaundice, or acute pancreatitis [3,12,13,16,[21][22][23][24][25][26][27][28]. Cysts of the parasite located in the body or tail of the pancreas can be asymptomatic and usually present as an abdominal lump when they enlarge [3,19,22,[29][30][31]. ...
Primary cystic echinococcosis of the pancreas is rare, even in endemic regions. The clinical presentation depends on the affected part of the pancreas and the presence of local complications, but there are no specific symptoms, which can be a clue to diagnosis. Imaging studies usually reveal avascular lesions in the pancreas that are most frequently misdiagnosed as pseudocysts or neoplastic cystic tumors. The treatment options vary from evacuation and drainage to formal resection of the pancreas, with no evidence of the best treatment strategy. This chapter provides a comprehensive review of the current knowledge of the clinical presentation, diagnosis, and treatment of primary cystic echinococcosis of the pancreas. Acute thrombosis of the splenic artery which leads to massive splenic infarction and abscess, a previously unreported initial manifestation of cystic echinococcosis of the pancreas is also presented, as well as the first use of intraoperative pancreaticoscopy to clear the mean pancreatic duct from membranes of the parasite.
... Acute pancreatitis is a rare presentation that may occur due to pancreatic ductal obstruction by external compression by the cyst or by internal occlusion by scolices after cyst-ductal communication [10]. Other rare complications include sinistral portal hypertension (by pancreatic tail lesions), rupture into the biliary tract, cholangitis, pancreatic fistula, and recurrent pancreatitis [1]. ...
... Other rare complications include sinistral portal hypertension (by pancreatic tail lesions), rupture into the biliary tract, cholangitis, pancreatic fistula, and recurrent pancreatitis [1]. Necrotising pancreatitis has also been reported [10]. In the present case, abdominal pain was the primary symptom although the patient had acute pancreatitis (mild) initially. ...
Abdominal hydatid cyst disease mostly involves the liver. Involvement of the pancreas as an isolated primary organ is rare accounting for < 2% of all systemic echinococcosis cases. It mostly involves the head of the pancreas. Symptoms depend on the location, size, and associated complications; therefore, it can have varied presentations including acute pancreatitis. On imaging, it can mimic other common pancreatic cystic lesions like pseudocyst or cystic neoplasm. Accurate preoperative diagnosis is usually difficult and requires a very high index of suspicion even in endemic areas. Herein, a case of primary isolated hydatid cyst of the pancreas that was initially diagnosed and managed as acute pancreatic pseudocyst is reported.
... There are no specific clinical signs when the cyst is located in the pancreatic body/tail, whereas obstructive jaundice may occur when the lesion is in the head of the pancreas, such as the presented case. Also, some cases may present acute pancreatitis firstly because of the main pancreatic duct obstruction [9,12]. Because of its rare incidence, pancreatic hydatid cysts are often misdiagnosed as other cyst types, such as pancreatic cystadenoma or cystadenocarcinoma. ...
Background
Hydatid cysts are parasitic zoonoses that often occur in the liver. Pancreatic hydatid cysts are very rare and are usually misdiagnosed as pancreatic cystadenomas. At present, surgical resection combined with albendazole administration is the standard treatment for pancreatic hydatid cysts. However, making accurate preoperative diagnoses and avoiding intraoperative cystic rupture are challenges for surgeons.
Case presentation
A 28-year-old woman from the pastoral area presented to the surgical office complaining of abdominal pain and new-onset jaundice that began 9 days earlier. An enhanced computed tomography scan demonstrated a 6.0 × 5.3 cm pancreatic head cystic mass that compressed the common bile duct and induced choledochectasia. The preoperative diagnosis was pancreatic head cystadenoma, and laparotomic pancreaticoduodenectomy was initiated successfully. The intra- and postoperative diagnosis was pancreatic hydatid cyst. The patient was discharged uneventfully 7 days after the operation. A 1-year course of albendazole (15 mg/kg/day) was admitted.
Conclusion
Pancreatic hydatid cysts are rare and often misdiagnosed as other types of cysts. History of living in an area in which the causative organism is endemic and positive anti-echinococcus IgG antibody status could help with the diagnosis. Radical resection combined with oral albendazole administration is the standard treatment for pancreatic hydatid cysts. Avoiding perioperative cystic rupture and abdominal echinococcosis implantation metastasis is crucial for the success of the operation.
... However, acute pancreatitis is a little-known complication of hydatid disease. The primary pancreatic location of hydatid cyst actually represents less than 1% of all cases reported in the literature [5,6]. It is responsible for a few cases of acute pancreatitis by cyst compression or migrated vesicle daughters' obstruction of the main pancreatic duct [7]. ...
Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques.
A thirty-year-old woman was referred to our emergency unit for acute pancreatitis. The CT-scan findings revealed a liver hydatid cyst ruptured in the biliary tract and daughter vesicles within were found, responsible for C-grade acute pancreatitis. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative cholangiogram that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence.
Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.
... However, acute pancreatitis is a little-known complication of hydatid disease. The primary pancreatic location of hydatid cyst actually represents less than 1% of all cases reported in the literature [36,37]. It is responsible for a few cases of acute pancreatitis by cyst compression or migrated vesicle daughters' obstruction of the main pancreatic duct [38]. ...
Background
Hydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques.
Case presentation
A thirty-year-old woman was referred to our emergency unit for acute epigastric pain evolving for four days. We found fever associated with epigastric guarding on physical examination. Laboratory tests showed inflammatory biological syndrome with frankly high serum lipase level and abnormal liver tests. The diagnosis of acute pancreatitis was set. We decided then to perform an abdominal ultrasound that showed dilatation of intra and extrahepatic biliary tracts without gallbladder stones. A cystic mass of the left liver was additionally found. On CT-scan, we found a C grade acute pancreatitis. Furthermore, a hydatid cyst of the left liver ruptured in the biliary tracts and daughter vesicles within were found. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence.
Conclusion
Cysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.
... The liver is the most common organ involved and, together with the lungs, account for 90% of cases. Other involved sites (less than 10% of cases) are muscles, bones, kidneys, brain, and spleen (Makni, A. et al., 2012). Hydatid acute pancreatitis, as a result of hydatid material that enters the bile duct, is a rare complication of hydatid liver disease, and there are only a few cases reported in the literature (Zeytunlu, M. et al., 2004). ...
Hydatid disease is a major health problem worldwide. The acute pancreatitis is a rare complication of this disease. We reported the case of 53 years-old man, who presented with upper abdominal pain, jaundice, a high level of lipase and Abdominal CT scan showed an hydatid cysts lesion and an inflammatory pancreas. Acute pancreatitis was treated in first time and after that a surgery was performed treating the hydatid liver cyst. The patient made an uneventful recovery after surgery.
