Hydatid cyst of the pancreas: Report of an undiagnosed case of pancreatic hydatid cyst and brief literature review

Table 1 Summary of demographic and clinic characteristics patients (n = 57) with pancreatic hydatid cyst published in the medical literature between January 2000 and April 2014

Ref.	Year	Country	Language	Paper type	Case count	Age (yr)	Sex	Complaint/examination findings	Cyst location	Cyst size (mm)	Serology
Trigui et al[4]	2013	Tunisia	English	Article	12	21	F	Epigastric mass + epigastric pain	Tail	NS	NS
						13	M	Epigastric pain + RUQ pain	Tail + Body	NS	NS
						15	M	Jaundice + RUQ pain	Head	NS	NS
						26	M	Epigastric pain	Head	NS	NS
						50	F	Epigastric pain	Head	NS	NS
						37	F	Jaundice + RUQ pain	Head	25	Negative
						8	M	Jaundice + RUQ pain	Head	83 × 76	Positive
						26	F	Pancreatitis + epigastric pain	TaİL + body	40	Positive
						61	F	Epigastric pain	Tail	NS	Positive
						11	F	Jaundice + RUQ pain	Head	NS	Negative
						16	F	Epigastric pain	Body	NS	Positive
						11	F	Jaundice + epigastric mass + RUQ pain	Head	50	NS
Yarlagadda et al[5]	2013	India	English	Case Report	1	43	M	Epigastric mass	Tail	180 × 170	NS
Patil et al[6]	2013	India	English	Case Report	1	47	M	Epigastric mass	Tail + Body	100 × 80	Positive
Kaushik et al[7]	2013	India	English	Case Report	1	18	F	LUQ pain	Tail	65 × 63	NS
Baghbanian et al[8]	2013	Iran	English	Case Report	1	46	M	Epigastric pain + fever	Tail	60 × 50	NS
Gundes et al[9]	2013	Turkey	Turkish	Case Report	2	24	F	Back pain	NS	70	NS
						50	F	Abdominal pain	Head	50	NS
Mandelia et al[10]	2012	India	English	Case Report	1	6	M	Jaundice + fever + epigastric mass	Head	54 × 41	Not-done
Kushwaha et al[11]	2012	India	English	Case Report	1	40	M	Epigastric mass + epigastric pain	Tail + Body	NS	Positive
Makni et al[12]	2012	Tunisia	English	Review	1	38	M	Abdominal pain + vomiting + nausea	Tail + Body	100 × 90	Positive
Karaman et al[13]	2012	Turkey	English	Case Report	1	32	M	Epigastric pain	Neck	55 × 45	Positive
Rayate et al[14]	2012	India	English	Case Report	1	30	F	Abdominal pain	Tail	62 × 57	Positive
Suryawanshi et al[15]	2011	India	English	Case Report	1	20	M	Epigastric mass + epigastric pain	Head	80 × 80	NS
Varshney et al[16]	2011	India	English	Case Report	1	35	M	Abdominal pain + vomiting + nausea	Tail	NS	Positive
Somani et al[17]	2011	India	English	Case Report	1	30	F	Epigastric mass + epigastric pain	Head	NS	NS
Masoodi et al[18]	2011	India	English	Case Report	1	45	M	LUQ mass	Tail	70 × 60	Positive
Makni et al[19]	2011	Tunisia	English	Case Report	1	30	F	Epigastric mass + discomfort	Body	80	Positive
Bhat et al[20]	2011	India	English	Case Report	1	4	F	Jaundice + epigastric mass	Head + Body	150 × 100	Negative
Cankorkmaz et al[21]	2011	Turkey	English	Case Report	1	7	F	Epigastric mass + weight loss	Tail + Body	70 × 60	Negative
Dalal et al[22]	2011	India	English	Case Report	1	48	M	Epigastric fullness + fever	Tail	80 × 50	Not-done
Agrawal et al[23]	2011	India	English	Case Report	1	5	F	Jaundice + abdominal pain	Head	120 × 100	NS
Küçükkartallar et al[24]	2011	Turkey	Turkish	Case Report	1	48	F	Abdominal pain	Head	28 × 25	Negative
Tavusbay et al[25]	2011	Turkey	English	Case Report	1	50	M	Abdominal mass	NS	NS	Positive
Derbel et al[26]	2010	Tunisia	English	Article	7	25	F	LUQ mass + LUQ pain	Tail	60	Negative
						19	F	Epigastric mass + RUQ pain	Tail	70	Negative
						32	F	Epigastric pain	Tail + body (two cyst)	150	Positive
						41	M	LUQ mass + LUQ pain + fever	NS	150	Negative
						38	M	Jaundice + epigastric pain	Head	50	Negative
						29	M	Jaundice + epigastric mass	Head	60	Negative
						25	F	LUQ pain + vomiting	Tail + Body	90	Positive
Bansal et al[27]	2010	India	English	Case Report	1	30	F	Jaundice + epigastric mass	Head	80 × 60	Not-done
Boubbou et al[28]	2010	Morocco	English	Case Report	1	38	M	Jaundice + epigastric pain	Head	NS	NS
Shah et al[29]	2010	India	English	Article	6	46	M	Epigastric pain	Tail	28	Positive
						37	F	Epigastric mass + vomiting	Body	26	Positive
						18	M	Dyspepsia	Body	33	Positive
						22	F	Epigastric pain	Tail	48	Negative
						28	M	Jaundice	Head	50	Positive
						68	M	Jaundice	Head	35	Negative
Karakas et al[30]	2010	Turkey	English	Letter	1	18	M	Abdominal pain + fever	Body	70 × 45	Negative
Diop et al[31]	2010	France	English	Case Report	1	29	M	Acute pancreatitis	Tail	35 × 25	Positive
Szanto et al[32]	2010	Romania	English	Case Report	1	49	F	Epigastric pain + bloating + vomiting	Tail	NS	NS
Cağlayan et al[33]	2010	Turkey	English	Article	1	70	M	NS	NS	NS	Positive
Orug et al[34]	2010	Turkey	English	Case Report	2	26	M	Abdominal pain + fatique + vomiting	Tail	115 × 95	NS
						57	F	Epigastric pain + weight loss	Tail	45 × 35	NS
Chammakhi-Jemli et al[35]	2010	Tunisia	French	Case Report	1	32	F	Acute pancreatitis + epigastric mass	Tail	80	Negative
Elmadi et al[36]	2010	Morocco	French	Case Report	1	7	M	Jaundice + fever + RUQ pain	Head	NS	Negative

RUQ: Right upper quadrant; LUQ: Left upper quadrant; NS: Not-stated.

Table 2 Detailed information regarding chief demographic data of the 57 patients included in the study

Ref.	Radiology	Surgical approach	Complication	Medical treatment	Recurrence	Follow-up (mo)	Other hydatid cyst focuses
Trigui et al[4]	NS	Distal pancreatectomy	No	NS	No	24	NS
	USG + CT	Partial cystectomy + drainage	Hemorrhage	NS	No	36	Liver + spleen + peritoneum
	USG + CT	Partial cystectomy + drainage	Pancreatic fistula	NS	No	24	Liver
	USG + CT	Partial cystectomy + drainage	Cavity infection	NS	No	NS	Liver + lung
	USG + CT	Partial cystectomy + drainage	Pancreatic fistula	NS	No	5	No
	USG + CT	Pancreaticoduodenectomy	Hemorrhage	NS	No	9	NS
	USG + CT	Partial cystectomy + duodenal fistula treatment	No	NS	No	24	NS
	USG + CT	Distal pancreatectomy + splenectomy	No	NS	No	36	Liver
	USG + CT	Distal pancreatectomy + splenectomy	No	NS	No	36	NS
	USG + CT	Cysto-duodenal anastomosis	No	NS	No	NS	Liver
	USG + CT	Partial cystectomy + drainage	No	NS	No	24	NS
	USG + CT	Cysto-duodenal anastomosis	No	NS	No	NS	NS
Yarlagadda et al[5]	USG + CT	Distal pancreatectomy + splenectomy	No	Albendazole-6 mo	No	6	No
Patil et al[6]	USG + CT	Distal pancreatectomy	No	Albendazole-3 wk	No	6	No
Kaushik et al[7]	USG + CT	Total cystectomy + marsupialisation	No	Albendazole-3 wk	No	6	NS
1Baghbanian et al[8]	USG + CT	Distal pancreatectomy + necrozectomy + partial nephrectomy	Died (POD15)	No	Died	Died	Kidney
Gundes et al[9]	NS	Partial cystectomy + omentoplasty	Wound infection	Albendazole-4 mo	No	NS	NS
	CT	Partial cystectomy + omentoplasty	Wound infection	Albendazole-4 mo	No	NS	No
2Mandelia et al[10]	USG + MRCP	Enucleation + cholangiography	No	Albendazole-3 wk	No	24	No
Kushwaha et al[11]	USG + CT	PAIR + epigastric cyst excision	Pancreatitis	Albendazole-3 mo	No	6	Kidney + peritoneum
Makni et al[12]	CT	Distal pancreatectomy + splenectomy	No	Albendazole-3 mo	No	8	No
3Karaman et al[13]	USG + CT	Percutaneous drainage	No	Albendazole-2 mo	No	18	No
Rayate et al[14]	USG + CT	Distal pancreatectomy	No	Albendazole-2 mo	No	7	No
4Suryawanshi et al[15]	USG + CT	Cyst evacuation + omentoplasty-laparoscopic	No	Albendazole-3 mo	No	3	No
5Varshney et al[16]	CT	Distal pancreatectomy	No	Albendazole-3 wk	No	10	No
6Somani et al[17]	USG + CT + ERCP	Pancreaticoduodenectomy	No	Albendazole-6 mo	NS	6	NS
7Masoodi et al[18]	USG + CT	Distal pancreatectomy + splenectomy	Hyperglisemia?	Albendazole-1 mo	No	6	No
Makni et al[19]	USG	Distal pancreatectomy + splenectomy	Pancreatic fistula	Albendazole-3 mo	No	8	No
Bhat et al[20]	USG + CT	Partial cystectomy + drainage	No	Albendazole-3 mo	No	24	No
8Cankorkmaz et al[21]	USG + CT	Partial cystectomy + drainage	Pancreatic fistula	NS	No	24	No
9Dalal et al[22]	USG + CT	Cyst excision along with tail of the pancreas	No	Albendazole-6 mo	No	8	No
10Agrawal et al[23]	USG + MRCP	Enucleation + cholangiography + cholecystectomy + cystography	No	Albendazole-2 mo	NS	NS	NS
11Küçükkartallar et al[24]	USG + CT + MRCP	Partial cystectomy + omentoplasty	No	Albendazole-4 mo	No	10	No
12Tavusbay et al[25]	USG + CT	Partial cystectomy + omentoplasty + splenectomy + mesenteric cyst excision	Wound infection	Albendazole-6 mo	No	12	Liver + spleen + peritoneum
13Derbel et al[26]	USG + CT	Partial cystectomy	No	No	No	35	No
	USG + CT	Partial cystectomy (for all cysts)	No	Albendazole-6 mo	No	9	Liver (13 cyst)
	USG + CT	Partial cystectomy for both pancreatic cysts	No	No	No	6	No
	USG + CT	Distal pancreatectomy	No	No	No	9	No
	USG + CT	Partial cystectomy (for all cyst)	Acute pancreatitis	Albendazole-6 mo	No	14	Liver
	USG + CT + MRI	Partial cystectomy	No	No	No	16	No
	USG + CT	Distal pancreatectomy + splenectomy	No	No	No	2	No
14Bansal et al[27]	USG + MRCP + EUS	Pancreaticoduodenectomy	No	Albendazole-6 wk	No	6	No
Boubbou et al[28]	USG + CT	PAIR + drainage + cystogastrostomy laparoscop	No	NS	NS	NS	NS
Shah et al[29]	USG + CT	Distal pancreatectomy + splenectomy	No	Albendazole-6 wk	No	120	No
	USG + CT	Central pancreatectomy + reconstruction	No	Albendazole-6 mo	No	96	No
	USG + CT + MRI	Pericystectomy	No	Albendazole-6 mo	No	52	No
	USG + CT	Distal pancreatectomy + splenectomy	No	Albendazole-6 wk	No	50	No
	USG + CT + MRI	Partial cystectomy + evacuation + T-tube drainage	No	Albendazole-6 mo	No	30	Liver
	USG + CT + MRI	Partial cystectomy + evacuation + T-tube drainage	No	Albendazole-6 mo	No	4	No
15Karakas et al[30]	USG + CT + MR	Distal pancreatectomy + cystectomy	Pancreatic fistula	NS	No	4	No
16Diop et al[31]	CT + MR + EUS	Distal pancreatectomy + polar nephrectomy + partial cystectomy-Liver	No	Albendazole-18 mo	No	48	Liver + kidney
Szanto et al[32]	USG + CT + EUS	Distal pancreatectomy + splenectomy	Hemoperitoneum	Not-used	No	NS	NS
Cağlayan et al[33]	NS	NS	NS	Albendazole	NS	NS	NS
Orug et al[34]	USG + CT	Distal pancreatectomy + splenectomy	No	Albendazole-6 mo	No	24	No
	USG + CT	Distal pancreatectomy + splenectomy	No	Albendazole-3 mo	No	24	No
Chammakhi-Jemli et al[35]	USG + CT + MRI	Distal pancreatectomy + splenectomy	No	NS	NS	NS	NS
Elmadi et al[36]	USG + MRI	Partial cystectomy + evacuation	No	NS	NS	24	No

¹This patient arrived at the hospital with signs of acute pancreatitis. Despite tienam therapy, he developed renal dysfunction and pancreatic necrosis that affected 50% of the organ. Due to deterioration in his overall status, the patient underwent distal pancreatectomy + necrosectomy + partial nephrectomy (for renal hydatid cyst). Unfortunately, the patient was lost on postoperative day 15;

²This patient was admitted to physician with episodes of obstructive jaundice and elevated liver function tests. Results from MRCP and US were both consistent with a choledocal cyst. An intraoperative cholangiography revealed normal bile flow;

³This patient underwent percutaneous drainage after 12 d treatment with albendazole. A cystogram was done, and there was no relationship between cyst and pancreatic duct. The patient received albendazole for 2 mo after the operation. The serologic test was negative during follow-up;

⁴This patient was tested for abdominal pain, leukocytosis, and hyperamylasemia and diagnosed with a pancreatic head cyst that compressed the duct externally. Subsequently, the patient developed acute pancreatitis secondary to ductus compression;

⁵No differential diagnosis was made on CT. Therefore, a FNAC was performed and cytologic examination revealed hooklets of parasite. The patient was administered a 21 d course of albendazole at pre-operative and post-operative periods;

⁶This patient developed jaundice 1 year ago and had elevated levels of AST and ALT. Findings from US, CT, and ERCP were consistent with a choledocal cyst. Thus, a stent was placed in the common bile duct, and a laparotomy operation was performed. After intraoperative exploration, the lesion was considered a cystadenoma. Whipple operation was performed since dissection of the cystic lesion was difficult;

⁷The patient was administered albendazole for 4 d preoperatively and 1 mo postoperatively. Postoperative hyperglycemia developed as a complication and was treated with insulin;

⁸A pancreatic pseudocyst was considered to exist, and a US-guided drainage was attempted. However, the cyst perforated into the peritoneal cavity during the procedure, and open surgery was performed and a pancreatic fistula developed. The drain was removed 18 d later;

⁹Clinical presentation and CT findings of this patient were consistent with an abscess. A US-guided aspiration was performed, and he culture result was sterile. Although the patient was sent home on medical therapy, he was admitted to the hospital again with signs of intestinal obstruction. A hydatid cyst was initially diagnosed, and a US-guided cytology confirmed hydatidosis;

¹⁰This patient was initially diagnosed with a choledocal cyst and underwent diagnostic laparoscopy. The cystic lesion originated from the pancreatic head and the aspirated fluid sample from the cyst clear fluid rather than bile. This finding indicated hydatid cyst, and an open operation was performed. Despite findings consistent with a pancreatic fistula on MRCP, no such relationship was detected in cytography. A cholangiography was carried out, and the fluid easily passed to duodenum;

¹¹MRCP images of this patient were consistent with a Type-II choledocal cyst;

¹²This patient had two previous hepatic hydatid cyst surgeries. He had cysts in liver, spleen, pancreas, and the area below the incision. Albendazole treatment was begun 3 wk prior to the operation. The operation team performed splenectomy + total peritoneal cyst excision + partial cystectomy + omentoplasty for two cysts in liver;

¹³The authors reported there was no relationship between hydatid cyst and common bile duct or pancreatic duct in any patient. Only 2 patients had bile duct dilatation secondary to compression of the common bile duct by hydatid cyst;

¹⁴USG revealed dilatation in bile ducts. MRCP was consistent with a type-III choledocal cyst. EUS showed a mass lesion originating from the pancreatic head. Since its intraoperative resembled a cystic neoplasm, a Whipple procedure was carried out. Examination of the specimen revealed the relationship between cyst and pancreatic duct;

¹⁵This patient had elevated liver function tests and increased blood amylase levels (acute pancreatitis) in preoperative testing. Radiologically, dilation of the pancreatic duct and enlargement of the pancreatic body were apparent. The patient received preoperative albendazole treatment. A fluid collection developed at the surgical area at the postoperative period, and a US-guided drainage catheter was placed. In addition, the pancreatic duct was stented, and external drainage dramatically improved after the stenting procedure;

¹⁶A pancreatic cyst was diagnosed in an examination performed for pancreatitis. MR and EUS localized the fistula between the pancreatic duct and cyst. USG: Ultrasonography; CT: Computed tomography; MRCP: Magnetic resonance cholangiopancreatography; ERCP: Endoscopic retrograde cholangiopancreatography; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; MRI: Magnetic resonance imaging; NS: Not-stated; FNAC: Fine needle aspiration cytology; US: Ultrasonography; EUS: Endoscopic ultrasound.