Pancreatic Fistula Following Surgery of Primary Pancreatic Hydatid Cyst Causing Pancreatitis

摘要

Background:Primary pancreatic hydatid cyst is rarely encountered and difficult to differentiate from pancreatic cyst neoplasm.The Aim:Of this case is to discus the mode of presentation and best management of this condition.Case Report:A twenty-eight year-old male presented with recurrent upper abdominal pain of three years duration. The pain was radiating to the back and associated with vomiting and low-grade fever.The ultrasound as well as CT scan with oral and I.V. contrast revealed that there was a solid-cystic mass in the tail of the pancreas suggesting of a pancreatic cystic tumor. Laparotomy revealed a pancreatic hydatid cyst, which was communicating with the pancreatic duct. The patient was treated by endocystectomy, which was complicated by pancreatic fistula.Conclusion:Pancreatic hydatid cyst should be kept in mind in any cystic lesion of the pancreas.This disease could be treated by endocystectomy or partial pancreatectomy. Introduction Hydatid disease can affect any part of the body from crown to the big toe and no tissue is immune except hair, nail and teeth. However, the liver is affected in 75-80% of the cases (1, 2, 3).This serious disease is caused by the larval stage of Echinococcis granulosus, which belongs to the Taenia family. It occurs throughout the world but is endemic in the Mediterranean, the Middle East, in South America, Australia, South Africa and Eastern Europe(2). Hydatid cysts of the pancreas are rarely encountered and few cases are reported(4).We report a rare case of a primary pancreatic hydatid cyst, which was communicating with the main pancreatic duct causing recurrent acute and chronic pancreatitis. Case Report A twenty-eight-years-old male presented with recurrent upper abdominal pain of three years duration. The pain was radiating to the back and associated with vomiting and low-grade fever. These attacks subsided one or two days later. During the last six months the pain became more severe and associated with watery diarrhea and weight loss. On examination, there was nothing significant except mild tenderness at the epigastric region. The investigation revealed: PCV 47, WBC 10.5x109 /L, eosinophils 5%, neutrophils 75%, ESR 75mm/h, TSB 14mmol/L and alkaline phosphate 87IU/L. Abdominal ultrasound revealed a multiloculated cyst 11.2x6cm in the body and tail of the pancreas with another mass in the head of the pancreas measuring 3x5cm, which was suggestive of a pancreatic cyst neoplasm (cystadenoma, cystadenocarcinoma) or pancreatic pseudocyst. Abdominal CT scan with oral and I.V. contrast revealed that there was a solid-cystic mass, hypodense in nature, 8x6cm, with multiple septae at the body and tail of the pancreas, and another hypodense mass at the head of the pancreas measuring 5x4cm. The picture was suggestive of pancreatic cystadenoma or pancreatic pseudocyst (figure 1).