Abstract
Context: Pancreatic hydatid disease is rare, occurring in less than 2% of all patients with hydatid disease. Multiple hydatid cysts of the pancreas have not been reported before. Case report: A 63 year old lady presented with chronic epigastric pain without weight loss, vomiting or jaundice. CT scan revealed multiple small cystic pancreatic lesions. There was no extra-pancreatic disease. Endoscopic ultrasound showed 10 cysts distributed throughout the pancreas with the largest being 1.3 cm. The aspirated fluid was mucin free, low in amylase and CEA. FNAC showed refractile structures and membranous remnants consistent with a hydatid cyst. The cyst distribution would have warranted a total pancreatectomy for complete extirpation. As the cysts were uncomplicated and relatively asymptomatic, a conservative non-operative approach was chosen. She has shown symptomatic improvement and has stable disease after 6 months with Albendazole treatment. Conclusion: Endoscopic ultrasound is useful in the diagnosis of pancreatic hydatid disease. In selected cases, non-operative management is an option that needs to be considered.
Highlights
Hydatid cyst or cystic echinococcosis is a zoonotic disease which may affect almost any visceral or peripheral tissue
Endoscopic ultrasound is useful in the diagnosis of pancreatic hydatid disease
Pancreatic hydatid cysts are rare with a reported frequency of 0.1-2% of all cases of hydatid disease [1,2,3,4,5]
Summary
Hydatid cyst or cystic echinococcosis is a zoonotic disease which may affect almost any visceral or peripheral tissue. A CT scan revealed small pancreatic cysts and a few calcifications in the pancreas (Figure 1). An Endoscopic Ultrasound (EUS) showed 10 cystic lesions spread throughout the pancreas, ranging in size from a few millimetres to 1.3 cm (Figure 2). EUS guided needle aspiration and cytology showed clear fluid with no mucin It revealed refractile structures consistent with parasitic body and membranous remnants reminiscent of a cyst wall in keeping with a hydatid cyst. As the cysts were small and uncomplicated, it was decided to treat them medically with albendazole at the dose of 10 mg/kg/day for 6 months She has shown symptomatic improvement on follow up and the disease has remained stable. Figure: CT scan showing at least 4 cysts in the body and tail of pancreas (white arrows)
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