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Abstract
Echinococcosis of the pancreas is extremely rare. The literature reports only about 200 cases of echinococcal cysts localized in the pancreas. The frequency of this localization is about 0.5% of echinococcosis cases.
The most common form is hydatid echinococcosis of the liver, which is usually combined with liver damage. It is believed that for every seven cases of liver echinococcosis, there is one case of its combination with echinococcosis of the pancreas.
Diagnosis of echinococcosis can be significantly complicated in some cases due to its unusual location. For example, the described localization of an echinococcal cyst in the main pancreatic duct. With a diagnosis of “pancreatic tumour”, the patient underwent pancreatoduodenal resection with removal of the “tumour”. Intraoperatively, the cysts were represented by fibrous tissue, with multiple septa on incision, but histological examination of the removed material confirmed the diagnosis of echinococcosis.
Cysts are usually located in the head of the pancreas, causing compression of the common bile duct. As a result of the toxic and sensitizing effects of the parasite and impaired outflow of pancreatic secretions due to compression of the pancreatic ducts by an echinococcal cyst, chronic pancreatitis develops, and less frequently, acute pancreatitis. The clinical picture of the disease is determined by both the compression of the common bile duct and the pancreatitis itself. Characteristic symptoms include abdominal pain, nausea, vomiting, a feeling of heaviness in the epigastrium, and a feeling of a lump in the left and/or right hypochondrium. The enlarging cyst compresses the pancreatic tissue, leading to its atrophy and decreased function, resulting in the development of hyperglycemia and glucosuria. Possible complications include rupture of the cyst into the abdominal cavity with the development of an acute abdomen, suppuration, and cyst petrification. When it gets really big, an echinococcal cyst can squeeze not only the common bile duct and pancreatic duct, but also the stomach, small intestine, and large intestine.
Pancreatic echinococcosis can usually be suspected on the basis of ultrasonography, computed tomography, and magnetic resonance imaging, which reveal a cyst with homogeneous contents and dense, often calcified walls. Medical history, eosinophilia, and especially cyst fluid analysis are of great importance. Scoleces are found in this fluid. The diagnosis of echinococcosis can be confirmed by indirect haemagglutination, latex agglutination, and basophil degranulation reactions with echinococcal antigen. When fluid is obtained from the cyst, a polymerase chain reaction is performed. When the cyst becomes infected, it transforms into a pancreatic abscess. In cases of hydatid echinococcosis, differential diagnosis with tumour cystic formations must be performed.
Pancreatic alveococcosis has a more severe course because the parasite is characterized by infiltrative growth and exogenous reproduction by budding. Alveococcal nodules usually invade the pancreas from the liver. Isolated pancreatic involvement is described as a rare or exotic manifestation. The disease is often accompanied by pancreatic and hepatic abscesses, cholangitis, and obstructive jaundice. The diagnosis is the same as for hydatid echinococcosis. Treatment is surgical in combination with antiparasitic agents and sarcolysin.
A clinical case of isolated pancreatic echinococcosis is presented. The described clinical observation and literature data justify the inclusion of isolated forms of echinococcosis not only of the liver, but also of other organs in the differential diagnosis in cases of an ambiguous picture of tumour or tumour-like formations.
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