# Primary Hydatid Cyst of the Pancreas: A Literature Review on a Rare and Challenging Occurrence of Echinococcosis

## TL;DR

This paper reviews rare pancreatic hydatid cysts caused by Echinococcus, focusing on their diagnosis, treatment, and outcomes based on recent literature and a unique case.

## Contribution

The study provides a comprehensive literature review and presents a unique case of primary pancreatic hydatid cysts over the last decade.

## Key findings

- Females are more frequently affected by pancreatic hydatid cysts (p < 0.001).
- Open surgery is the preferred approach for certain pancreatic localizations (p < 0.001).
- Radical procedures are more common than conservative ones (52.5% vs. 47.5%).

## Abstract

Hydatid disease is caused by the Echinococcus tapeworm and is a zoonosis that endemically affects certain geographic areas with a high prevalence in animal husbandry. Due to globalization, the pathology can also be encountered beyond these preferred geographic areas. It predominantly affects the liver and lungs, with pancreatic localizations of hydatid cysts being rare and posing a challenge for differential diagnosis and surgical tactics. The present study aimed to provide a recent scoping of the literature on this type of localization, analyzing demographic data, therapeutic management, and postoperative outcomes. It was observed that females are more frequently affected in pancreatic hydatid localizations (p < 0.001), with the most common symptomatology represented by abdominal pain. The preferred localization was at the level of the pancreatic tail (32.5%), followed by cephalic localizations (25%). The preferred surgical approach was open surgery, with an observed preference for open surgery in specific localizations, such as the head, isthmus, and body of the pancreas (p < 0.001). Radical procedures are more commonly used than conservative ones (52.5% vs. 47.5%), and paradoxically, although less invasive, procedures such as inactivation and drainage are associated with more frequent complications (p = 0.03). This type of localization, due to the elements of local anatomical topography, requires adequate preparation in biliopancreatic surgery, considering that sometimes preoperative diagnosis is not oriented, and intraoperative records may require extensive interventions. Our research encompassed a thorough review of literature spanning the last decade using PubMed and Google Scholar databases, focusing specifically on cases involving primary hydatid cysts found within the pancreas. Thirty-three relevant articles were published between 2014 and 2024. In addition, we presented a unique case study that illustrates this uncommon occurrence.