Hydatid Cyst of the Pancreas: A Diagnostic Dilemma

Background : Hydatid cyst of the pancreas is rare and differentiating from more common cystic lesions of the pancreas is difficult preoperatively. Patients and Methods : Retrospective analysis of consecutive patients with intra-abdominal hydatid disease in our center from January 2000 to December 2017. We identified six patients with pancreatic hydatid cyst during the study period, which made our study group. Results: Of 310 patients with intra-abdominal hydatid cysts, only 6 (1.9%) patients had pancreatic hydatid cysts. The age ranged from 14 to 48 years, and all six were female. Pain was the predominant symptom in all patients, associated with abdominal mass in four patients, nausea in 2 patients, and fever in 1 patient. Intracystic bleeding complicated one patient. Cysts were isolated to the pancreas in all cases, being located in the head of the pancreas in one patient, body in one patient, tail in two patients, body and tail of the pancreas in two patients. The average size of the cyst was 8.8 cm (range: 5 to 14 cm). Hydatid serology was positive in three patients; therefore, accurate preoperative diagnosis was established in only three patients (50%). Besides albendazole therapy, four patients underwent open surgery, and two underwent laparoscopic surgery. Surgical procedures included emergency distal pancreatico-splenectomy, cysto-pericystectomy, deroofing with and without Roux-en-Y cysto-jejunostomy, and distal pancreatectomy. The patients did well with a mean follow-up of 41.5 months, without recurrence. Conclusion : Primary pancreatic hydatid cysts are rare, difficult to diagnose, and timely intervention avoids life-threatening complications. Cyst-enteric anastomosis in patients undergoing deroofing may prevent pancreatic fistula, and laparoscopic surgery is feasible and safe.