Multiple Hydatid Cysts of the Pancreas: A Literature First

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.