Acute pancreatitis caused by hydatid membranes in the biliary tract: treatment with endoscopic sphincterotomy.

Hydatidosis is a zoonosis that is generally caused by infection with Echinococcus granulosus. When the parasite eggs are ingested by human beings, the infective forms (oncospheres) penetrate the intestinal wall and reach the liver via the portal circulation.1 In some cases, the hydatid cyst subsequently ruptures into the biliary tract.1-4 A few cases of acute pancreatitis associated with the presence of hydatid membranes in the biliary tract have been described.5-14 However, this rare complication has not been noted in recent reviews.1-4 Additionally, when the pathogenic factors of acute pancreatitis are described, rupture of the hepatic hydatid cyst has not been considered among them.15,16 Patients who have pancreatitis caused by hydatid membranes in the biliary tract have been treated, generally, by surgery. To date, only two cases treated by endoscopic sphincterotomy and membrane extraction have been described.9,11 Over the past 5 years, we have encountered three cases of acute pancreatitis (two of them recurrent) caused by the presence of hydatid membranes in the biliary tract and in which the problem was resolved by endoscopic sphincterotomy.