Primary hydatid cyst masquerading as pseudocyst of the pancreas with concomitant small gut obstruction—an unusual presentation

Abstract

Isolated retroperitoneal hydatid cyst is an exceptionally rare entity. Owing to vague and varied symptomatology, it is seldom diagnosed without puncture cytology or surgery. We report an unusual presentation of primary retroperitoneal hydatid cyst with concomitant small gut obstruction. Ultrasonography and computed tomography of the abdomen showed localized abscess or pseudocyst of pancreas. Preoperatively, ultrasound-guided puncture cytology of the lesion revealed suspicious hydatid pathology. The patient was examined and, peroperatively, the cyst masqueraded as hydatid cyst of pancreas along with an inflammatory band, and the diagnostic dilemma about its exact site of origin was solved by histopathology only. Complete excision of the cyst along with the tail of pancreas was done with concomitant excision of inflammatory band, causing small intestinal obstruction. The patient was discharged in satisfactory condition on albendazole. In follow-up of 8 months, there was no recurrence.

Hydatid cyst of the pancreas: Report of an undiagnosed case of pancreatic hydatid cyst and brief literature review

“…Karaman et al [13] 2012 [14] 2012 India English Case Report 1 30 F Abdominal pain Tail 62 × 57 Positive Suryawanshi et al [15] 2011 India English Case Report 1 20 M Epigastric mass + epigastric pain Head 80 × 80 NS Varshney et al [16] Somani et al [17] 2011 India English Case Report 1 30 F Epigastric mass + epigastric pain Head NS NS Masoodi et al [18] 2011 India English Case Report 1 45 M LUQ mass Tail 70 × 60 Positive Makni et al [19] 2011 Tunisia English Case Report 1 30 F Epigastric mass + discomfort Body 80 Positive Bhat et al [20] 2011 India English Case Report 1 4 F Jaundice + epigastric mass Head + Body 150 × 100 Negative Cankorkmaz et al [21] 2011 Turkey English Case Report 1 7 F Epigastric mass + weight loss Tail + Body 70 × 60 Negative Dalal et al [22] 2011 India English Case Report 1 48 M Epigastric fullness + fever Tail 80 × 50 Not-done Agrawal et al [23] 2011 India English Case Report 1 5 F Jaundice + abdominal pain Head 120 × 100 NS Küçükkartallar et al [24] 2011 Tavusbay et al [25] 2011 Turkey English Case Report 1 50 M Abdominal mass NS NS Positive Derbel et al [26] 2010 [27] 2010 India English Case Report 1 30 F Jaundice + epigastric mass Head 80 × 60 Not-done Boubbou et al [28] 2010 Morocco English Case Report 1 38 M Jaundice + epigastric pain Head NS NS Shah et al [29] [30] 2010 [32] 2010 Romania English Case Report 1 49 F Epigastric pain + bloating + vomiting…”

“…Trigui et al [4] Patil et al [6] USG + CT Kaushik et al [7] USG + CT Baghbanian et al [8] USG + CT Distal pancreatectomy + necrozectomy + partial nephrectomy Karaman et al [13] USG + CT [14] USG + CT Suryawanshi et al [15] USG + CT Cyst evacuation + omentoplasty-laparoscopic Varshney et al [16] Somani et al [17] USG Masoodi et al [18] USG + CT Distal pancreatectomy + splenectomy Dalal et al [22] USG + CT Cyst excision along with tail of the pancreas Agrawal et al [23] USG + MRCP Enucleation + cholangiography + cholecystectomy + cystography Tavusbay et al [25] USG + CT Partial cystectomy + omentoplasty + splenectomy + mesenteric cyst excision Wound infection Albendazole-6 mo No 12 Liver + spleen + peritoneum 13 Derbel et al [26] USG + CT …”

“…Using percutaneous fine needle aspiration cytology (FNAC) for the differential diagnosis of cystic pancreatic lesion, Varshney et al [16] showed hooklets of hydatid cyst cytologically. In contrast, Dalal et al [22] had to perform FNAC twice in order to diagnose hydatid cyst. Anaphylaxis and pouring of cyst content into the abdominal cavity are potential complications of the FNAC procedure.…”

A Giant Splenic Hydatid Cyst

“…Th e ELISA test has a sensitivity of about 90% and a specifi city of 90% for hepatic cysts, 55% for lung hydatid disease, and 45% for hydatid disease in other organs. Th ese tests, however, may be negative because the capsule isolates the parasite from the host's immune system (11,12).…”

Comparative Evaluation of Ultrasonography and Computed Tomography in Pancreatic Lesions

“…Hence, the final diagnosis of isolated primary retroperitoneal hydatid cyst of the pancreas was made, as other organs of the body did not reveal any hydatid cyst. 15 Fine needle aspiration cytology together with imaging, had become a primary diagnostic modality for investigation of pancreatic mass lesions, both cystic and solid. Despite the advances in the imaging techniques, management options for patients were limited and a malignant diagnosis of solid lesions still carried a high mortality rate.…”