We report the case of a 54-year-old man with a history of sigmoidectomy for volvulus who developed chronic colonic dilatation requiring repeated colonic exsufflation. Abdominal CT imaging revealed pancolonic distension and a large (11 × 9 × 13 cm) multilocular pancreatic tail cyst causing segmental portal hypertension (Figure 1). Hydatid serology was positive, suggesting a diagnosis of a pancreatic hydatid cyst. The patient underwent an exploratory laparotomy. Intraoperatively, the entire colon was distended (Figure 2A), and a well-defined cys t ic lesion was found in the pancreatic tail, which was densely adherent to the spleen and associated with collateral venous circulation (Figure 3A). We performed a subtotal colectomy (Figure 2B) without immediate restoration of intestinal continu ity, combined with partial resection of the pancreatic hydatid cyst (Figure 3B). The cyst contents, consisting of non-infected multivesicular fluid (Figure 3C), were completely evacuated. A drain was placed in the residual cavity. Postoperative recovery was uncomplicated, with no recurrence at 6-month follow-up.

Hydatid disease remains a significant public health concern in Tunisia [1]. Although the liver is the predominant site of infec tion, isolated pancreatic involvement is extremely uncommon, representing only 0.14-2% of systemic echinococcosis cases [2].

Due to their rarity, pancreatic hydatid cysts are often misdi agnosed as other cystic pancreatic lesions. Preoperative diagno sis requires multimodal imaging (contrast-enhanced CT, MRI, or ultrasound) combined with hydatid serology [2,3].

Surgical treatment is mandatory, with the approach (radi cal or conservative) depending on the cyst’s location relative to the mesenteric-portal pedicle, anatomical relationships, and complications [3]. In our case, the cyst’s proximity to the spleen, presence of segmental portal hypertension, and need for concurrent colectomy necessitated a conservative surgical approach.

1. C Cöl, M Cöl, H Lafçi. Unusual localizations of hydatid disease. Acta Medica Austriaca. 2003; 30: 61-4.
2. Yilei Wu, Jun Gong, Wei Xiong, Xiaojiong Yu, Xiangyu Lu. Primary pancreatichydatid cyst: A case report and literature review. BMC Gastroenterol. 2021; 21: 164.
3. Bharati Hiremath, Narayana Subramaniam, Manobhiram Bogga varapu. Primary pancreatichydatid cyst: An unexpected differen tial diagnosis. BMJ Case Rep.2015: bcr2015211377.