Acute pancreatitis as a rare complication of rupture of hydatid liver cyst: review of 16 cases

Abstract

Hydatid disease HD or echinococcosis is a parasitic disease caused by Echinococcus granulosus. The prevalence of this parasitic disease in Morocco approximates 2 to 3% in highly endemic regions such Atlas Mountains. Liver is the main affected organ, and cholangitis is the most frequent complication of Hydatic liver cyst, however acute pancreatitis remain a very rare complication of the disease as showed by the very few cases reported in the literature. Its treatment combines the management of acute pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) and surgical treatment of the cyst. We report a series of 16 patients diagnosed for hydatid cyst of liver with pancreatitis at the University Hospital Hassan II to show the interest and outcomes of the management of such complication . We retrospectively review the clinical presentation and outcomes of management of 16 patients admitted for hydatid cyst of liver with acute pancreatitis at the department of hepato gastroenterology at the university Hospital Hassan II between January 2013 and July 2018. The average age of our patients was 44.33 years [20;66] with a female predominance. Only 12.5% (n = 2) of the patients had past history of surgical cure of liver hydatid cyst. All patients had acute pancreatitis associated with cholangitis. Abdominal CT scan showed oedematous pancreatitis in 87.5% (n = 14) and the necrotizing pancreatitis in 12.5% (n = 2). The common bile duct (CBD) was dilated in all patients and the kystobiliary fistula was identified in 68.75% (n=11). ERCP was performed for all our patients, cholangiogram showed filling defect in distal CBD and a communication between intra-hepatic biliary duct with the hydatid cyst. Sphincterotomy was performed with evacuation of membranes in 87,5%. Acute pancreatitis is an exceptional complication of hydatic liver cyst. It is often associated with cholangitis. The ERCP combined to surgery remain the key treatment.