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Abdominal mass in a young male

Clinical scenario:  
         A 35-year-old male farmer had noticed a swelling of the left side of his hypochondrium that persisted for six months. He had no history of severe abdominal pain, jaundice or fever. There was no history of loss of appetite or weight loss.
Examination:
       The patient was conscious and oriented. Icterus, lymphadenopathy, and edema were absent. The examination of his abdomen revealed a swelling that measured 5x6 cm. The swelling was smooth and cystic. In order to confirm the origin of this swelling different maneuvers were used. The swelling disappeared while raising his head suggesting an intraabdominal nature of the swelling. The patient was asked to assume the knee-elbow position and the swelling was palpated in this position. The said swelling disappeared confirming the retroperitoneal nature of this swelling. There was no bruit on auscultation. The results of the systemic examination were normal.


Evaluation: 
         He had normal levels of hemoglobin(Hb= 13.6gm/dl), white cell count and erythrocyte sedimentation rate were normal as well.
Tests of kidney and liver function were normal and serum amylase levels were not increased. His
chest X-ray was normal. On ultrasound examination, there was a 7x6 cm swelling surrounding the
pancreas was documented. The liver, gallbladder and other organs were normal. His abdominal computed tomography
Fig 1 CT scan abdomen showing Cyst in the tail region of Pancreas 
(CT) revealed a cyst in the tail of the pancreas but the pancreatic duct was not dilated. The cyst was 5x6 cm in diameter, and had jagged margins but did not contain daughter cysts. All other organs were normal (Figure 1). No additional cystic lesions were seen in any other organ. IgG antibodies to E. granulosus were detected by enzyme-linked immunosorbent assay (ELISA).
Course: 
       The patient was given albendazole 15 mg/kg perioperatively, and distal pancreatectomy and enucleation of the cyst with proper precautions were done to prevent anaphylaxis.
Splenectomy was also performed and hemostasis was achieved. A drain was left in place after the procedure. Histopathology was suggestive of a hydatid cyst.
The patient had high blood sugars postoperatively and was managed with insulin subcutaneously. He had an uneventful course. He was discharged from the hospital after eight days. The patient's blood sugars are under control with insulin. The patient was monitored for six months in our outpatient department.

Teaching message : 
            The hydatid cyst  may be considered as one of the differential diagnosis  in the cystic lesions of the pancreas 

Further Reading:      Hydatidosis

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