A Primary Pancreatic Hydatid Cyst With Concomitant Hepatic Involvement Mimicking Mucinous Cystadenoma: A Case From an Endemic Region

TL;DR

A rare case of pancreatic hydatid cyst in a woman from an endemic region was misdiagnosed initially but correctly identified and treated with surgery and medication.

Contribution

This case highlights the importance of considering hydatid disease in pancreatic cystic lesions in endemic regions, especially with concurrent liver involvement.

Findings

The patient had cystic lesions in the pancreas and liver caused by Echinococcus granulosus.

Surgical and medical treatment with albendazole successfully managed the disease.

The case emphasizes the need for early diagnosis to prevent complications in endemic regions.

Abstract

Pancreatic hydatid disease is an exceptionally rare manifestation of Echinococcus granulosus infection. Its clinical and radiological resemblance to other cystic pancreatic lesions often delays diagnosis and treatment. Here, we describe a case of a 71-year-old woman from Lebanon, who presented with progressive epigastric and right upper quadrant pain. Initial endoscopic examination revealed a benign gastric ulcer. Six months later, she developed obstructive jaundice and cholangitis. Examination showed scleral icterus and mild right upper quadrant tenderness. Laboratory tests revealed leukocytosis, markedly elevated transaminases, cholestatic enzyme elevation, and hyperbilirubinemia, with elevated C-reactive protein (CRP), consistent with acute cholangitis. Imaging identified cystic lesions in the pancreatic head and liver, initially suggestive of mucinous cystadenoma. Endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting relieved symptoms, but follow-up imaging demonstrated progressive lesion enlargement. Hydatid disease was suspected, given the concomitant hepatic cyst and endemic background. Surgical exploration confirmed cystic lesions in both organs, and histopathology established E. granulosus infection. The patient underwent Roux-en-Y cystojejunostomy and completed a postoperative course of albendazole without complications. Hydatid disease should be considered in the differential diagnosis of pancreatic cystic lesions in endemic areas, particularly when hepatic cysts coexist. Early recognition and combined surgical-medical management are essential to prevent complications and recurrence.

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