CASE REPORT


https://doi.org/10.5005/jp-journals-10033-1566
World Journal of Laparoscopic Surgery
Volume 16 | Issue 2 | Year 2023

Laparoscopic Distal Pancreatectomy for Primary Pancreatic Hydatid Cyst with Lateral Portal Hypertension: A Case Report


Shahbaz Bashir1https://orcid.org/0000-0002-8559-8130, Mubashir Ahmad Shah2, Irshad Ahmad Kumar3https://orcid.org/0000-0002-6451-5535, Irfan Nazir Mir4

1–3Department of General Surgery, Government Medical College Srinagar, Shopian, Jammu and Kashmir, India

4Department of Surgery, SKIMS SOURA, Srinagar, Jammu and Kashmir, India

Corresponding Author: Irshad Ahmad Kumar, Department of General Surgery, Government Medical College Srinagar, Shopian, Jammu and Kashmir, India, Phone: +91 7006122289, e-mail: irshadahmadkumar@gmail.com

How to cite this article: Bashir S, Shah MA, Kumar IA, et al. Laparoscopic Distal Pancreatectomy for Primary Pancreatic Hydatid Cyst with Lateral Portal Hypertension: A Case Report. World J Lap Surg 2023;16(2):101–104.

Source of support: Nil

Conflict of interest: None

Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.

Received on: 01 August 2022; Accepted on: 20 February 2023; Published on: 19 December 2023

ABSTRACT

Hydatid cysts of the pancreas are quite uncommon. Even more uncommon are pancreatic hydatid cysts associated with portal hypertension. The illness may manifest either simultaneously with systemic involvement or as an isolated pancreatic involvement. Both of these scenarios are possible. We provide the first instance of a patient who had a laparoscopic distal pancreatectomy for treatment of a pancreatic hydatid cyst associated with lateral portal hypertension. There were neither complications nor recurrences of the condition. A male patient of 25 years old was brought into our facility complaining of epigastric and back discomfort. The patient’s upper abdominal contrast enhanced computed tomography showed a unilocular cystic lesion (10 cm × 9 cm × 7 cm) in the tail of the pancreas, coupled with several collaterals at the splenic hilum, along the greater curvature of the stomach, and at the pylorus. He had a laparoscopic procedure of distal pancreatectomy, along with a splenectomy. His recovery from surgery went well, and a histological analysis revealed a hydatid cyst in both the pancreatic tail and body.

Keywords: Case report, Hydatid cyst, Pancreatic surgery, Portal hypertension.

INTRODUCTION

Because of the broad availability of cross-sectional imaging methods, a rising number of pancreatic cystic neoplasms, the vast majority of which are found in asymptomatic individuals, are being detected.1 Studies have shown that the occurrence of pancreatic hydatid cysts is less than 1%. This indicates that they are a relatively uncommon condition.2 The illness may manifest either simultaneously with systemic involvement or as an isolated pancreatic involvement. Both of these scenarios are possible.

We present what we believe to be the first case ever documented in the worldwide medical literature of a patient who had laparoscopic distal pancreatectomy combined with splenectomy in order to treat a pancreatic hydatid cyst that was accompanied with lateral portal hypertension.

CASE DESCRIPTION

A male patient aged 25 years who had a history of one episode of malena was hospitalized at our hospital complaining of epigastric discomfort that had been steadily worsening over the previous 3 weeks. There was no history of either medical treatment or surgical procedure. In respect to the pancreatic tail, a USG examination also showed an anechoic region with uneven boundaries of 7 cm × 8 cm × 7 cm. A unilocular cystic lesion of 10 cm × 9 cm × 7 cm was discovered by CECT (Fig. 1) in the body and tail of the pancreas. This lesion caused an obstruction in the splenic vein and several collaterals at the splenic hilum and along the greater curvature of the stomach.

Fig. 1: CT scan showing pancreatic cyst

One trocar with a 12 mm size, one with a 10 mm size, and two with a 5 mm sizes were inserted. The cyst was uncovered when the opening in the lesser sac was made. Ligaclips and hormonic were used in order to split the short gastric vessels in addition to the significantly dilated collaterals. A large cyst and the distal portion of the pancreas were removed from the retroperitoneum during the procedure. The attachments of the spleen were severed during the procedure. Close to the cyst, both the splenic artery and vein were severed and clamped with a surgical clip. Endostapler was used in order to section the pancreatic tissue. Finally, the cyst was mobilized, and the cyst and the distal pancreas as well as the spleen were removed by dissection. After that the specimen was extracted via a smaller incision that was made in the connection between the two 5 mm holes. An incision was made in the pancreatic cyst, and a layered hydatid membrane was extracted from the cyst (Fig. 2).

Figs 2A to F: (A) Left; (B) Right; Dissecting distal pancreas along with huge cyst; (C) Doing distal pancreatectomy; (D and E) Laminated hydatid membrane retrieved from the cyst; (F) Collaterals around distal pancreas

The patient was released without any issues 5 days after the procedure since his postoperative course was uncomplicated. The presence of a hydatid cyst in the pancreas was shown by the postoperative histological examination. CECT scans performed as a follow-up confirmed that there was no fluid accumulation and neither was any sign of recurrence.

DISCUSSION

When a pancreatic cystic lesion is detected in areas where Echinococcus granulosus is an endemic pathogen, it is important to take into mind the possibility of pancreatic hydatid cysts. In circumstances in which there is not also a contemporaneous hydatid cyst lesion in the liver, as was the case with our patient, the process of diagnosis is made much more challenging. The liver, followed by the lung, is the organ that is most often affected by the proliferation of parasites. Even in regions of the world where echinococcal illness is frequent, hydatid cysts developing in the pancreas are a rather rare occurrence. The existence of a serous cyst adenoma is the most prevalent form of a differential diagnosis that may be made between a hydatid cyst and a pancreatic cystic tumor. Even though it is very uncommon, pancreatic hydatidosis need to be taken into consideration when making a differential diagnosis of cystic lesions of the pancreas in the right epidemiological context.

About 50–57% of the cases, 24–34% of the cases, and 16–19% of the cases, respectively, have the pancreatic hydatid cysts positioned in the head of the pancreas, the corpus of the pancreas, and the tail of the pancreas.3 The majority of instances of pancreatic hydatid cyst are characterized by the presence of a single lesion.

The clinical appearance might vary greatly depending on the location of the pancreatic cyst and how far it has spread throughout the pancreas. The primary clinical symptoms, which were seen in our patient, were pain and discomfort in the epigastric region, as well as vomiting. The external compression of the common bile duct may be a contributing factor in the development of obstructive jaundice. Cysts that were positioned in the body or the tail almost never produced any symptoms and could only be identified by their existence as a mass and the following impact it had. A complication, such as a rupture into the biliary tree or into the peritoneal cavity, abscess development, or the compression of splenic vein producing portal hypertension, as was found in our case, might nonetheless disclose the presence of a hydatid pancreatic cyst. Only via surgical removal of the pancreas can a definite diagnosis of hydatid disease of the pancreas be obtained.

Surgical procedures, both open and laparoscopic, as well as minimally invasive treatments, biopsy-aspiration-injection-reaspiration, and medicinal therapy are all potential alternatives for treating the condition.4 Open surgical procedures have been accepted as the gold standard among the treatment options;4 however, developing surgical techniques and technologies have enabled laparoscopic operations for hydatid cysts to be performed more safely.4 In patients who are wanting to undergo full resection without opening the cyst, laparoscopic surgical procedures that are conducted by skilled surgeons are at least as effective and safe as open surgical procedures. This is particularly true in cases when the cyst is not going to be opened.5 Faraj et al.6 were the first to describe a laparoscopic partial cystectomy for an isolated pancreatic hydatid cyst that did not result in any recurrence for a period of six months. Resection with clean margins should be conducted without opening the cyst until it can be shown that there are no cystic neoplasms present.

CONCLUSION

A primary infection of the pancreas with E. granulosus, which results in the development of hydatid cysts, is a disease that occurs infrequently. Cystic lesions of the distal pancreas, such as hydatid cysts, are amenable to laparoscopic excision, and the procedure is completely risk-free. It may be possible to keep the rates of complications and recurrence to a minimum by performing the necessary surgical resection followed by the necessary medicinal therapy.

ORCID

Shahbaz Bashir https://orcid.org/0000-0002-8559-8130

Irshad Ahmad Kumar https://orcid.org/0000-0002-6451-5535

REFERENCES

1. https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18716113.

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5. Mehrabi A, Hafezi M, Arvin J, et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 2015;157(1):45–55. DOI: 10.1016/j.surg.2014.06.081.

6. Faraj W, Selmo F, Khalifeh M, et al. Laparoscopic resection of pancreatic hydatid disease. Surgery 2006;139(3):438–441. DOI: 10.1016/j.surg.2005.10.004.

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