Acute Pancreatitis as a Complication of a Hydatid Liver Cyst

TL;DR

A rare case of a liver hydatid cyst causing acute pancreatitis is presented, highlighting the need for careful diagnosis and treatment.

Contribution

This paper reports a rare clinical scenario where a hydatid liver cyst led to acute pancreatitis and discusses its management.

Findings

A 67-year-old female presented with acute pancreatitis caused by a hydatid liver cyst.

Laparoscopic unroofing and cholecystectomy were successfully performed with a favorable outcome.

Combined treatment with albendazole, ERCP, and surgery is recommended for such cases.

Abstract

Introduction and Importance: Cystic echinococcosis is a common cystic infection in endemic areas. Solitary lesions are commonly found in the liver and are primarily caused by Echinococcus granulosus. Other organs can be involved as well but to a lesser degree. This paper presents a rare manifestation of a hydatid liver cyst causing acute pancreatitis.

Case Presentation: A 67-year-old female presented with right upper quadrant pain, nausea, and vomiting. She was found to have a large hepatic cystic echinococcosis occupying the right lobe of the liver with associated acute pancreatitis. After endoscopic retrograde cholangiopancreatography (ERCP), three small yellow membrane fragments—presumed to be daughter cyst membranes—were found obstructing the common bile duct at the ampulla of Vater. The patient underwent laparoscopic unroofing of the hepatic cystic echinococcosis and laparoscopic cholecystectomy with an uneventful postoperative course.

Clinical Discussion: Treatment modalities for hepatic cystic echinococcosis depend on the size of the cyst, imaging findings, cyst activity status, and associated complications. In nonendemic countries, where demographic changes occur due to travel from endemic regions, a high index of suspicion is necessary for timely diagnosis. A laparoscopic approach was chosen for its benefits related to minimally invasive surgery. While laparoscopic management of hepatic cystic echinococcosis is well described, its use in cases complicated by acute pancreatitis remains infrequently reported.

Conclusion: Cystic echinococcosis most commonly presents in the liver. When associated with acute pancreatitis, a combined approach involving albendazole, ERCP, and sphincterotomy is typically required, with surgical resection depending on cyst classification.

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