Acute pancreatitis during liver hydatidosis: treatment with ERCP and endoscopic sphincterotomy

The Authors report on a case of a young woman who developed acute pancreatitis when affected by liver hydatidosis, successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy.

An endoscopic sphincterotomy was performed, with extraction of multiple hydatid membranes.

Laboratory values returned to normal within 36 hours of the sphincterotomy. The patient was dismissed with oral therapy (Albendazole 400 mg bis in die for 4 months) and antibodies to Echinococcus were not detectable 1 month later. One year later, at ultrasound and CT the hydatid cyst was regressed and patient was still without symptoms.

Hydatid membranes in the biliary tract should be considered as a potential cause of pancreatitis in patients with hydatidosis, even if it is a rare complication, caused by the obstruction of the distal part of common bile duct by fragments of hydatid membranes, scolices or daughter cysts. ERCP may be beneficial, but surgery remains the treatment of choice for treatment of liver hydatid cysts.