Hydatid cyst, hydatid echinococcosis or hydatidosis, is a parasitic disease caused by the eggs of a tapeworm called Echinococcus granulosus. It belongs to the larval cestodes. It is a complex zoonosis affecting many species of animals. It accidentally affects humans, who are an intermediate host in the helminthiasis cycle [5].

Pancreatic localization is rare, representing 0.2 to 2% [6] and the cyst has an intraparenchymal development in 35% of cases and peripheral development in 65% of cases [7,8].%

Pancreatic localization is isolated in 91% of cases. The site is most often cephalic in 57% of cases, corporeal in 24% of cases and caudal in 19% of cases [9].

The route taken by the parasite is the superior mesenteric artery after passage of both hepatic and pulmonary or local filters from the liver through the pancreato-biliary ducts [7,10,11]

In the pancreas, the cyst gradually increases in size, ranging from a few millimetres to more than 20 cm, pushing back the pancreatic parenchyma, compressing and then eroding the surrounding organs. Thus, KHP has no specific clinical signs and the symptomatology depends on the location and size of the cyst [8,12,13].

Epigastralgia is the most common reason for consultation. Certain progressive complications may suggest the presence of a hydatid cyst of the pancreas, such as obstructive jaundice in the case of cysts located in the head of the pancreas, cyst abscess, chronic pancreatitis, rupture of the cyst in the intra-abdominal or retroperitoneal cavity, fistulization of the cyst in one of the neighboring organs and segmental portal hypertension. Mesenteric infarction has also been documented as a consequence of thrombosis of the superior mesenteric artery by compression exerted by the hydatid cyst. In addition, cyst fistulization in the Wirsung duct can lead to recurrent episodes of acute pancreatitis or even wirsungorrhagia [13].

Ultrasound, computed tomography and magnetic resonance imaging have no difficulty in recognizing the pancreatic cystic lesion, but the difficulty is to link this lesion to the hydatid disease [9].

Radiological features that distinguish hydatid cysts from other cystic lesions of the pancreas are the presence of curvilinear calcifications of the cyst wall, the presence of daughter vesicles, debris known as hydatid sand, septa, detachment of the hydatid membrane, or association with other more obvious hydatid cyst (liver) locations [11,14].

In the event that there is still a diagnostic doubt, the use of endoscopic ultrasound is of great benefit because it allows a better study of the cystic content [15].

A positive hydatid serology usually confirms hydatid disease, but the percentage positivity seems lower compared to the hepatic and pulmonary location. However, the negativity of serology does not eliminate the hydatid nature of a pancreatic cystic mass [16].

Diagnostic needle aspiration is formally contraindicated because of the risk of retro- or intraperitoneal dissemination [17]

The differential diagnosis is made with other macrocystic tumors of the pancreas. The pseudocyst is distinguished from the hydatid disease by the absence of a clean wall. Cystadenoma and cystadenocarcinoma are characterized by the enhancement of the intracystic edges and septa after injection of the contrast agent with a CT scan [18].

The anamnesis plays a crucial role in the diagnosis of hydatidosis by looking for risk factors such as contact with dogs and the socio-professional context. The examination also makes it possible to look for the notion of previous intervention on hepatic hydatidosis and the existence of an acute accident suggestive of the rupture or cracking of a hydatid cyst [19].

Thus, the comparison of preoperative data, in particular the anamnesis which plays a crucial role in the diagnosis of hydatidosis by looking for risk factors such as contact with dogs and the socio-professional context, the clinics, radiological (ultrasound, computed tomography, MRI and possibly endoscopic ultrasound) and serology allow, in the majority of cases, to confirm the hydatid nature of a pancreatic cystic mass [13].

The treatment of hydatid cyst of the pancreas is surgical. The location of the cyst and the presence or absence of a ductal cystic fistula make it possible to dictate the surgical action to be taken [8]. Thus, for hydatid cysts of cephalic location, resection of the protruding dome with or without epiplooplasty and drainage of the residual cavity by a large drain given the non-negligible risk of postoperative pancreatic fistula, is the therapeutic choice [9]. Cephalic duodenopancreatectomy seems to be a disproportionate procedure in the face of this benign parasitic condition [20].

Some authors suggest the systematic administration of Sandostatin® at induction and postoperatively for seven days for preventive purposes, since the residual cavity of a hydatid cyst of the pancreas is considered to be the equivalent of a slice of pancreatic section, with a non-negligible risk of postoperative pancreatic fistula. [13].

In the case of a cystic-ductal fistula, a cystic-digestive anastomosis such as a cystic-gastric or cystic-duodenal anastomosis, or a cyst-jejunal anastomosis on a Y-loop should be preferred to external drainage or resection of the protruding dome because of the resulting complications. In case of friable pancreatic tissue not showing up on anastomosis, a root canal suture on a stake drain is indicated [9,21].

For corporeo-caudal localization, a left pancreatectomy removes the cyst and sutures the pancreas into healthy tissue. Resection of the protruding dome is considered for large cysts adhering to neighbouring organs with the risk of dissection which can be dangerous [13].

The introduction of albendazole is indicated in cases of intraoperative rupture of the cyst or multiple hydatidosis [22].