Surgery of the pancreatic cystic echinococcosis: systematic review

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

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.

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.

Primary pancreatic hydatid disease: A rare presentation of echinococcosis

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.

Management of a pancreatic tail hydatid cyst: a case report

The case report describes a 73-year-old woman, with a history of diabetes, who presented with left hypochondrium pain. Interrogation revealed a long-term history of living with Echinococcus granulosus endemic area, associated to close contact with sheep and dogs. Upon physical examination, a painless mass of the left hypochondrium, fixed to the deep plane. Abdominal ultrasonography (USG) showed a 9 cm encapsulated mass in contact with the tail of the pancreas. Further investigation was carried out by performing an abdominal computed tomography (CT) scan showing: large cystic mass with a partially calcified thickened wall, containing multiple vesicles, measuring 11.5 cm, located at the tail of the pancreas. The patient was put under Albendazole for a week and then operated on. During laparotomy, a hydatid cyst was located in the tail of the pancreas. Conservative treatment was done sparing the healthy pancreatic parenchyma and avoiding major surgery for a diabetic patient.

Isolated primary hydatid cyst of the pancreas: Management challenges of a cystic masquerade

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.

One-tube nested MGB Probe Real-time PCR assay for detection of Echinococcus multilocularis infection in plasma cell free DNA

INTRODUCTION

The main objective of this study was to develop a One-tube nested MGB probe real-time PCR Assay for detecting Echinococcus multilocularis infection in human plasma cell free DNA (cfDNA).

METHODS

cfDNA was extracted from 10 E.m.-infected patients using a NucleoSnap DNA Plasma Kit and characterized by genomic sequencing. We designed nested PCR primers and MGB probe for Echinococcus multilocularis detection. The specificity, sensitivity and reproducibility of this assay were analyzed, and its validity was confirmed in 13 early stage clinical samples.

RESULTS

Several Echinococcus multilocularis-specific sequences were detected in the cfDNA of E.m.-infected patients, and CBLO020001206.1 was selected as the candidate sequence. We designed the primers and probe for the one tube nested real-time PCR. No cross-reactions with E.g. were observed. The detection limit was as low as 1 copy for Echinococcus multilocularis. The coefficients of variation were lower than 5% in intra- and inter-assays. 11 out of 13 patients were positive with nested MGB Probe PCR Assay and 3 patients were positive without outer primer in early stage Alveolar Echinococcosis pateints.

CONCLUSION

The one-tube nested MGB probe real-time PCR assay is a simple, rapid, and cost-effective method for detection of Echinococcus multilocularis infection in patients' Plasma DNA.

A Case Report of Liver and Pancreatic Echinococcal Cysts

A 54-year-old female patient with complaints of abdominal pain for 2 months was admitted to the General Surgery clinic of our tertiary care hospital. Abdominal ultrasound (US) and computed tomography revealed cholelithiasis, liver hydatid cyst, and hypodense multicystic mass lesion in the pancreatic body. In the endoscopic US performed, pancreatic hydatid cysts were considered as the pre-diagnosis. Cystotomy and external drainage were performed on the 8-cm cystic lesion in the pancreas head-class junction. Pancreatic hydatid cyst can be rarely seen isolated or can develop synchronously to liver hydatid cyst, and should be kept in mind in a differential diagnosis. If the perioperative diagnosis is confirmed and in case of the absence of a pancreatic ductal fistula, surgical morbidity and mortality can be reduced by applying cystotomy and external drainage procedures.

Primary pancreatic hydatid cyst: a case report and literature review

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.

Acute pancreatitis as an uncommon complication of hydatid cyst of the liver: A case report and systematic literature review

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.

Staged management of a giant cardiac hydatid cyst: a case report

BACKGROUND

We report on a 21-year-old patient with a giant symptomatic hydatid cyst of the interventricular septum, to whom a staged management approach was employed. Induction medical therapy led to a reduction in the size of the cyst, which was then completely removed via surgical excision.

CASE PRESENTATION

A 21-year-old male Caucasian, with main complaints of fatigue and palpitations, was referred to our Centre due to a cystic formation in his left ventricle. The workup consisted of transthoracic echocardiography and cardiac magnetic resonance, which revealed a huge hydatid cyst in an active stage of disease, occupying the basal and mid part of the interventricular septum. Due to the size of the lesion and lack of viable myocardium in the affected area, the patient was declared inoperable and medical therapy was initiated. Serial echocardiography revealed a significant reduction in the size of the lesion and degradation to transitional and inactive stage, after which successful surgical excision of the cyst was performed. In the course of the medical treatment, the patient experienced sustained ventricular tachycardia causing loss of consciousness, which did not reoccur after surgical excision.

CONCLUSION

Medical therapy can result in the degradation of a giant heart hydatid cyst, enabling surgical excision. Heart hydatid cyst can lead to potentially lethal arrhythmia irrespective of its size and stage, which does not reoccur after successful surgical excision.