Epigastric Mass Due to a Hydatid

Seyed Reza Moosavi, Houman Khajouei Kermany
Department of General and Vascular Surgery, Shohada-e Tajrish Medical Center,
Shahid Beheshti University of Medical Sciences. Tehran, Iran
ABSTRACT
Context Primary hydatid disease of the
pancreas is very rare.
Case report We report the case of a
30-year-old man who presented with
abdominal pain and an epigastric mass. A
diagnosis of a pancreatic cyst was established
by ultrasonography and CT scan before
surgery. The treatment consisted of the
resection of the protruding dome with a
cystogastrostomy. The recovery was
uneventful and the patient has remained
symptom free so far.
Conclusions Hydatid disease should be
considered in the differential diagnosis of all
cystic masses in the pancreas, especially in
the geographical regions where the disease is
endemic.
INTRODUCTION
Pancreatic location of hydatid disease is
extraordinarily rare, with an incidence of less
than 1% as compared to the other sites of
hydatid disease [1, 2]. Establishing a precise
diagnosis may be difficult because the
presenting symptoms and the findings of
clinical investigations may be similar to other
more commonly encountered cystic lesions of
the pancreas [3]. Clinical presentation varies
according to the anatomic location of the cyst.
Abdominal pain, discomfort and vomiting are
the main clinical symptoms. The patient may
present with obstructive jaundice, weight loss,
an epigastric mass, and/or recurrent acute
pancreatitis [4, 5]. The diagnosis is based on
an enzyme-linked immunoadsorbent assay
(ELIZA) test for echinococcal antigens,
which is positive in over 85% of infected
patients [6]. Ultrasonography will typically
demonstrate a cyst with a wall of varying
thickness. Computed tomographic findings,
such as rounded cystic lesions with
curvilinear calcification may allow the
diagnosis to be made in the appropriate
clinical setting [7]. A definitive diagnosis of
hydatid disease of the pancreas can be made
only at surgery and, during surgical treatment
of hydatid cysts, extreme caution must be
taken to avoid rupture of the cysts which
would release protoscolices into the peritoneal
cavity. Multiple surgical procedures, such as
proper evacuation, pericystectomy and
omentoplasty, are possible. A hydatid cyst in
the tail of the pancreas can be successfully
treated with a distal pancreatectomy [8, 9].
In this article, we present the case of a patient
with an isolated hydatid cyst of the pancreas.
CASE REPORT
The patient was a 30-year-old man who
presented in January 2006 to our hospital with
epigastric pain, occasional vomiting, and an

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JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 8, No. 2 - March 2007. [ISSN 1590-8577]
233
epigastric mass of 3 month duration. On
physical examination, the vital signs were
normal. The only positive sign besides a hard
epigastric mass was mild tenderness.
Ultrasonography and CT scan showed a cyst
at the head of the pancreas, 6x8 cm in
diameter (Figure 1). The hydatid cyst was
recognized before surgery on the basis of the
epidemiological data and the existence of a
calcified shell. The indirect hemagglutination
test was positive. The patient underwent
midline transperitoneal laparotomy and an
isolated hydatid cyst of the pancreas was
found without communication to the
pancreatic duct. The content of the cyst was
removed without any spillage and a
cystogastrostomy was performed. The patient
was started on 800 mg/day albendazole after
surgery. Recovery was uneventful and the
patient has remained symptom free so far.
DISCUSSION
We emphasize the low incidence of hydatid
disease in a pancreatic site (0.2-2% in the
literature) [1, 2, 10]. The most common
differential diagnosis between a hydatid cyst
and pancreatic cystic tumors is the presence
of a serous cyst adenoma. Though very rare,
pancreatic hydatidosis should be considered
in the differential diagnosis of cystic lesions
of the pancreas in the appropriate
epidemiological setting. In the literature, the
surgical treatment of pancreatic hydatid
disease is complete excision of the cyst, but
this has the potential risk of spillage or of
damaging the pancreatic tissue, however, it
seems that when we have a large cyst with
extensive adherence to the surrounding
pancreatic parenchyma, a cystogastrostomy
may be a satisfactory treatment. When there is
a lack of surgical radicality, we should
consider adjuvant medical therapy with
benzoimidazoles (e.g, albendazole).
Received January 8
th
, 2007 - Accepted
February 1
st
, 2007
Keywords
Echinococcosis;
Surgical
Procedures, Operative; Pancreatic Cyst
Correspondence
Seyed Reza Moosavi
Shahid Beheshti University of Medical
Siences
Shohada-Tajrish,MedicalCenter
Tehran
Iran
Phone: +98-21.227.8001-12
Fax: +98-21.227.2144; +98-21.228.62756
E-mail: seyed29@yahoo.com
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a
b

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JOP. Journal of the Pancreas - http://www.joplink.net - Vol. 8, No. 2 - March 2007. [ISSN 1590-8577]
234
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