Surgery of the pancreatic cystic echinococcosis: systematic review

Abstract

The prevalence of pancreatic cystic echinococcosis (PCE) in the world is low ranging between 0.2% and 0.6%. The diagnosis of PCE is easy when it is associated to other location such as liver, it became difficult when PCE was isolated simulating other diagnosis such as pseudocyst, a choledochal cyst, serous or mucinous cystadenoma and cystadenocarcinoma. This systematic review aimed to provide evidence-based answer to the following questions: (I) what are the efficient tools to affirm the diagnosis of isolated PCE and (II) what are the best therapeutic strategy for the PCE? An electronic search was performed by two authors (W Dougaz, I Bouasker). Medline, Scopus, Embase, Web of Science, Google Scholar and Cochrane collaboration were consulted. The keywords used were "cyst", "echinococcosis", "hydatid cyst" and "pancreas". All abstracts were analyzed followed by extraction of the full text by the same two authors (W Dougaz, I Bouasker), all divergences were resolved by discussion with C Dziri. Recommendations were based on Oxford's classification: (I) what are the efficient tools to affirm the diagnosis of PCE? -ultrasound remains the cornerstone of diagnosis. Magnetic resonance imaging (MRI) reproduces the ultrasound defined features of CE better than computed tomography (CT). MRI with heavily T2-weighted series is preferable to CT. Pancreatic duct MRI should be promising to identify a fistula between PCE and pancreatic duct (level of evidence 3-recommendation B); (II) what are the best therapeutic strategy for the PCE? -surgery is the main treatment of PCE. Open approach is validated. The decision depends of the location of PCE: head body and/or tail of the pancreas (level of evidence 5-recommendation D): for the head of the pancreas, the tendency is toward conservative surgery. For body and/or tail of the pancreas, the tendency is toward radical surgery. Medical treatment (albendazole) should be prescribed 1 week before surgery and 2 months during postoperative period (level II evidence and grade C recommendation).

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

“…However, acute pancreatitis is a little-known complication of hydatid disease. The primary pancreatic location of hydatid cyst actually represents less than 1% of all cases reported in the literature [36,37]. It is responsible for a few cases of acute pancreatitis by cyst compression or migrated vesicle daughters' obstruction of the main pancreatic duct [38].…”

Infected Pancreatic Hydatid Cyst with Cysto-Pancreatic Fistula Presenting as Acute Pancreatitis

“…4,7 Open surgery is the treatment of choice with the type of surgery dependent on the site of the cyst. 8 Endoscopic retrograde cholangiopancreatography plays no role in either the diagnosis or treatment but may be used for palliation and bridge to surgery in patients with cystopancreatic fistula, leading onto pancreatitis or infection, as was done in the index case. 2,3 Minimally invasive techniques such as USG-guided percutaneous drainage, using hypertonic (20%) saline or absolute alcohol as scolicidal agents, have been successfully used for noncommunicating hepatic as well as renal hydatid cysts.…”

Primary Pancreatic Echinococcosis: A Rare Cause of Pancreatic Cyst

“…The main symptoms are pain epigastrium (69%) or in left upper quadrant (31%), vomiting 16%, Jaundice 26%, and Fever in 8%. Association with acute pancreatitis was seen in 15% patients [4]. Enzyme-linked immunoadsorbent assay test for echinococcal antigens is positive in over 85% of infected patients [6].…”

“…The incidence varies from 0.14% to 2.0% in endemic countries [3]. The prevalence of Pancreatic cystic echinococcosis is low -0.2 -0.6% [4]. The Tail of pancreas is most frequent location 47% followed by the head 31% than the tail 22% [5].…”