Komplike kist hidatikte sýradýþý bir tablo: Nekrotizan pankreatit

Hidatik akut pankreatit nadir görülen ve her zaman akut ödematöz pankreatit olarak seyreden bir tablodur. Karaciðer kist hidatiðinin safra yollarýna açýlmasý ve papiller açýklýðýn hidatik membranlarla týkanmasý olasý mekanizmalardan biridir. Epigastrik ve sað üst kadran aðrýsý, bulantý, kusma þikayetiyle baþvuran 49 yaþýnda erkek hastanýn bilgisayarlý tomografi incelemesinde karaciðer sol lobunda 5x5 cm ebatlarýnda kistin safra yollarýna açýlarak nekrotizan pankreatite yol açtýðý görüldü. Endoskopik retrograd kolanjiyopankreatikografi denemesinin baþarýsýz olmasý nedeniyle hastada kistotomi, koledok eksplorasyonu, T-Tüp drenaj ve omentoplasti operasyonu tercih edildi. Nekrotizan pankreatit için ilave giriþim yapýlmadý. Klinik ve laboratuvar bulgularý hýzla düzelen hastada bir yýllýk takip süresinde tekrar pankreatit geliþimi saptanmadý. Hidatik ödematöz ve nekrotizan pankreatit benzer kliniðe sahiptir, papillada bulunan týkanýklýðýn ortadan kaldýrýlmasýyla iyileþme süreci hýzlý ve sorunsuz olmaktadýr.

An unusual appearance of complicated hydatid cyst: necrotizing pancreatitis

Hydatid acute pancreatitis is a rare condition and always presents as consequence of acute edematous pancreatitis. Intrabiliary rupture of hepatic hydatid cysts and obstruction of papillary orifice with hydatid membrane is possible mechanism. A 49-year-old man was admitted with epigastric and right upper quadrant pain, nausea, and vomiting. Computed tomography scan showed 5 x 5 cm cyst in left hepatic lobe, which had ruptured into the biliary tract and caused necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography trial failed. Surgical choice was drainage of cyst, insertion of T-Tube, exploration of common bile duct and omentoplasty. No additional necessary surgical intervention was necessary for necrotizing pancreatitis. Clinical and laboratory findings resolved rapidly and there was no recurrent pancreatitis episode during 1 year of follow-up. Hydatid edematous and necrotizing pancreatitis have similar progress. Recovery is quick and uneventful after elimination of mechanical obstruction of papillary orifice.