Acute Pancreatitis as an Uncommon Complication of Hydatid Cyst of the Liver: A Case Report and Systematic Literature Review .

Abstract

BackgroundHydatid disease is a major health problem worldwide. The liver is the most frequent location of hydatid disease. Acute pancreatitis secondary to liver hydatid cyst ruptured in the biliary tract is scarce and fewly described in literature. The management of this pancreatic complication of liver hydatid disease is challenging and includes a combination of surgical and endoscopic approaches. We report herein a rare case of hydatid cyst of the liver with cysto-biliary communication revealed by acute pancreatitis. A systematic literature review of similar cases reported was provided to compare surgical and endoscopic techniques. Case presentationA thirty-year-old woman was referred to our emergency unit for acute epigastric pain evolving for four days. We found fever associated with epigastric guarding on physical examination. Laboratory tests showed inflammatory biological syndrome with frankly high serum lipase level and abnormal liver tests. The diagnosis of acute pancreatitis was set. We decided then to perform an abdominal ultrasound that showed dilatation of intra and extrahepatic biliary tracts without gallbladder stones. A cystic mass of the left liver was additionally found. On CT-scan, we found a C grade acute pancreatitis. Furthermore, a hydatid cyst of the left liver ruptured in the biliary tracts and daughter vesicles within were found. We decided then to perform an emergency surgery through a bisoucostal incision. We performed a cholecystectomy and a peroperative that showed the communication between the cyst and left biliary tracts and the presence of daughter vesicle within the common bile duct. We conducted an exploration of the common bile duct with extraction of vesicle daughters. We left behind a T-tube in the common bile duct and we sutured the cysto-biliary fistula. Drainage was left in the remnant cavity after unroofing the cyst. Postoperative course was uneventful. Six months follow-up showed no recurrence.ConclusionCysto-biliary communication of liver hydatid disease revealed by acute pancreatitis is uncommon. We chose to perform emergency open surgery. However, through a systematic literature review, we noticed that endoscopic treatment is an efficient therapeutic and diagnostic tool to delay a morbid surgery of the liver and the common bile duct.