Primary hydatid cyst of the pancreas with a hepatic pedicule compression

An incidentally diagnosed primary pancreatic body hydatid cyst: A case report and literature review

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.

ATYPICALLY LOCATED HYDATID CYST CASES: 4 UNUSUAL CASE REPORTS

Objective: Hydatid cyst is endemic in South America, the Middle and Far East and around the Mediterranean. The disease is frequently located in liver (65-70%) and lungs (25%). Hydatid disease is usually asymptomatic when located in the extrahepatic regions. Sometimes, diagnosis can be established in the patients, who were taken to operation with non-specific findings, by observing germinative membrane, rockwater, or daughter vesicles during the operation. The aim of the present study is to present the hydatid cyst cases detected in the anterior of the left abdominal acetabulum, head of the pancreas, in the perianal region, and on the right adrenal gland. Case 1: A 41-year-old female patient applied to our clinic with the complaint of intermittent left inguinal pain. echinococcus Indirect Hemagglutination (IHA) test was positive. In the ultrasonographic examination, a hypoechoic area was observed in the posteromedial of the left femoral head. Cystic lesion was observed in computed tomography (CT) and magnetic resonance imaging (MRI). Pathology result of the patient was assessed as “compatible with hydatid cyst”. Case 2: A 56-year-old female patient, applied with the complaints of intermittent nausea, vomiting, and epigastric pain. She had a history of surgery for liver hydatid cyst 15 years ago and for lung hydatid cyst 10 years ago. IHA test of the patient was positive. The lesion involving septation and accompanied by calcifications around the cyst was reported as a hydatid cyst at dynamic CT for pancreas and upper abdominal MRI. Case3: A 22-year-old female patient applied with perianal pain complaint. Drainage was planned for the patient who had a pre-diagnosis of perianal abscess. Tissues similar to the hydatid cyst membrane were excised together with purulent fluid. The patient was diagnosed with hydatid cyst after the pathology result was reported “as compatible with hydatid cyst”. Case4: A 32-year-old female patient had a non-metabolic adrenal subcapsular cyst (hydatid cyst?) in the right adrenal gland on ultrasonography performed for abdominal pain. In abdominal tomography, a “cystic mass compatible with hydatid cyst located in the adrenal gland in the upper pole of the right kidney” was reported. IHA test of the patient was negative. Surgical intervention was not considered for the patient, who was thought to be diagnosed with adrenal hydatid cyst with a calcified membrane, and follow-up decision was taken. DISCUSSION AND CONCLUSION Echinococcus eggs infect people with direct contact with water, food, and dogs. Echinococcus eggs infect people with direct contact with water, food, and dogs. From the intestines, the larvae reach the liver through the veins. Sometimes they cause the disease by passing through the liver or reaching the lungs via lymphatics. Then, they can reach other places in the body, less frequently through the blood. It is known that Turkey is in an endemic region in terms of hydatid cyst. Hydatid cysts located in the perianal region and muscles have been reported as atypical localizations in the literature, and some of them were diagnosed as a result of preoperative clinical evaluation and radiological imaging. Some were diagnosed as a result of pathological examination after the operation. Surgical treatment is an option in suitable cases, and the definitive diagnosis can be established by pathology. Consequently, it should be considered that cystic lesions detected in the patients living in endemic regions can be extrahepatic hydatid cyst that is localized in different anatomical regions.

A rare case of pancreatic head hydatid cyst

Hydatidosis or Echinococcosis is a parasitic disease caused by infection with the larval stage of Echinococcus granulosus. Primary isolated pancreatic hydatidosis is very rare even in countries where echinococcosis disease is highly endemic. The objective of this case report is to highlight this unusual and rare hydatid cyst presentation to avoid incorrect diagnosis and management. In our case, preoperative evaluation guided the diagnosis toward cystic pancreatic neoplasms, leading us to contemplate a radical surgical approach (Pancreaticoduodenectomy). Pancreatic hydatid cysts can be confused with cystic pancreatic neoplasms, it should always be considered as a differential diagnosis in endemic areas, to prevent misdiagnosis and inappropriate management.

Pancreatic body hydatid cyst: A case report

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Pancreatic hydatid cyst is rarely reported.

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Due to its rarity and similarity with more common pancreatic cystic conditions, diagnosis of pancreatic may be a challenging.

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Past history of travelling to endemic ares should raise suspiscion to the possibility of hydatid disease.

INTRODUCTION

Hydatid disease is a parasitic infestation caused by the cystic stage of Echinococcus granulosus. Hydatid cysts are commonly located in the liver and lung. Pancreatic affection by hydatid cysts is very rare even in endemic areas.

PRESENTATION OF CASE

Our case is a 34-year-old male patient referred to our centre with a pancreatic body cyst diagnosed by abdominal CT scan. The patient gave 3 months history of epigastric pain. He also gave history of travelling to Saudi Arabia and China. His enzyme-linked immunoadsorbent assay (ELIZA) test for echinococcal antigens was positive. Surgical exploration revealed a 7 cm cyst in the body of the pancreas separable from the surroundings. Endocystectomy and deroofing of the cyst was done.

DISCUSSION

Due to its rarity and similarity with more common pancreatic cystic conditions, diagnosis of pancreatic hydatid cyst may be challenging. Abdmonial sonography and CT scan together with enzyme-linked immunoadsorbent assay (ELIZA) test for echinococcal antigens are helpful diagnostic tools. Therapeutic options include endocystectomy and deroofing, albendazol therapy with percutaneous drainage or laparoscopic excision of the cyst.

CONCLUSION

Even in non-endemic areas, past history of travelling abroad in patients with pancreatic cystic lesions should raise the suspicion of hydatid disease as a possible diagnosis.

Primary pancreatic echinococcosis

Hydatid disease is an endemic and common zoonosis in India. Liver is the most common site of infection. However, extra hepatic primary pancreatic hydatid cyst is rare. We report a case of primary hydatid cyst in the tail of pancreas compressing the adjacent organs in a 43-year-old male who presented with abdominal mass and was diagnosed as pancreatic cyst/splenic cyst by ultrasonography. Computed tomography of abdomen revealed a large cystic lesion in the tail of pancreas suggestive of a pseudocyst of pancreas. The case was managed surgically by splenectomy and distal pancreatectomy with albendazole therapy. Microbiological Investigations of aspirated fluid revealed free hooklets and invaginated scolices of Echinococcus granulosus, which was correlated with histopathological findings.