A rare location of papillary carcinoma: Thyroglossal duct cyst.

The inadequate closure of the thyroglossal tract paves the way for a thyroglossal cyst. Thyroglossal duct cyst (TDC) malignancy is quite rare. A thirty-nineyear-old female patient was admitted to the polyclinic with a complaint of palpable mass in the neck. Findings compatible with TDC were determined in the patient's neck screening and it was considered to be malignant due to irregular margins, apparent vascularization and punctual calcifications. Fine needle aspiration biopsy was unremarkable. TDC was excised by Sistrunk procedure and frozen examination was performed. Total thyroidectomy was performed additionally since the result of the frozen examination was found to be compatible with the primary papillary carcinoma of TDC. If preoperative biopsy does not provide a diagnosis, frozen section study will be beneficial in terms of both providing the early diagnosis and directing the operation strategy during the surgery in clinically or radiologically suspected patients.

Primary Hyperparathyroidism with Thyroid Cancer: Clinicopathologic Features.

Objectives: Concomitant thyroid disease affects almost half of the primary hyperparathyroidism (PHPT) patients. Pre-operative evaluation of the thyroid gland for the early diagnosis of thyroid carcinoma is essential in PHPT patients. Herein, we aim to investigate the clinicopathologic features that affect the type and extent of surgery in patients having PHPT and concomitant thyroid disease but especially thyroid cancer. Methods: The files of consecutive patients who underwent parathyroidectomy for PHPT during a 6-year period were retrospectively reviewed. The cases who underwent parathyroidectomy and simultaneous thyroidectomy were enrolled in the study. A total of 84 patients who met the study criteria were divided into two groups as benign thyroid disease (Group 1) and malignant thyroid disease (Group 2) according to the final histopathological examination. The demographic and clinicopathological characteristics were compared between groups. Results: Concomitant thyroid disease was found in 158 (55.6%) of 284 patients who were operated on for PHPT. Simultaneous total thyroidectomy or lobectomy was performed for 84 (29.6%) patients and thyroid carcinoma was detected in 29 (10.2%) patients. Total thyroidectomy and complication rates were higher in Group 2 (p<0.05). Pre-operative fine-needle aspiration biopsy was obtained in 58.3% of patients and it identified only 26.3% of histopathologically confirmed thyroid carcinoma. Only pre-operative serum phosphorus level was found higher in Group 1 (p<0.05), but none of the study parameters was found as an independent risk factor for thyroid malignancy (p>0.05) in multivariate analysis. Conclusion: There is no accepted parameter yet to predict the accompanying thyroid carcinoma in PHPT patients. However, a benign biopsy cannot exclude thyroid malignancy in PHPT patients and may cause undiagnosed thyroid carcinoma due to papillary microcarcinoma.

Intrathyroidal Parathyroid Adenomas in Primary Hyperparathyroidism: Clinical and Imaging Findings.

Objectives: Primary hyperparathyroidism (PHPT) is a common endocrine disease. Ectopic adenomas may cause a failed surgery which results in persistence or recurrence. Intrathyroidal parathyroid adenoma (ITPA) is a rare reason for PHPT and site of ectopia. Herein, we aimed to investigate the clinical and imaging features of patients with ITPAs and the effectiveness of radiological tools for localization at a tertiary reference center. Methods: The files of 708 consecutive patients who underwent parathyroidectomy for PHPT in our department between January 2007 and December 2021 were investigated retrospectively. PHPT patients with ITPA were included in the study. Patients with missing data were excluded from the study. Clinicopathological features of the patients and radiological evaluation findings were investigated. Results: Twenty-eight (28/708: 3.9%) patients were included in the study. The complete intrathyroidal gland and subcapsular parathyroid gland were observed in 8 (1.1%) and 20 (2.8%) patients, respectively. The ultrasound and parathyroid scintigraphy revealed the accurate localization of ITPA in 25 (89.3%) and 18 (64.3%) patients, respectively. Additional imaging modalities were applied for 10 patients in which conventional localization studies were discordant or inconclusive. ITPAs were most commonly found in the lower gland (n=20) localization. All patients had a successful parathyroidectomy and neither persistence nor recurrence was occurred in the study group. Conclusion: The ITPAs are rare in PHPT. The ultrasound has a high diagnostic rate in experienced hands. The second-line imaging methods may be favorable in the presence of negative or discordant scans. The pre-operative localization studies can detect the ITPAs in most patients, so blind thyroidectomy should be avoided.

Perforated hemorrhagic cholecystitis in a patient with Bernard-Soulier syndrome.

Bernard-Soulier syndrome is an inherited coagulopathy, with an incidence of one per million. Hemorrhagic cholecystitis is a rare and life-threatening complication of acute cholecystitis. Less than 50 patients have been reported in the previous literature. Bleeding diathesis and anticoagulant treatment are well-known predisposing factors for hemorrhagic cholecystitis. We present a 57-year-old male patient who was referred to our department with a complaint of right upper quadrant abdominal pain. Contrast-enhanced computed tomography revealed a high-density mass associated with the gallbladder lumen, and blood clot in the gallbladder lumen and hemoperitoneum which were compatible for hemorrhagic cholecystitis and gallbladder perforation. The patient underwent urgent cholecystectomy. Hemorrhagic cholecystitis often manifests as typical acute cholecystitis presentation; but several clinical findings such as fever, lower gastrointestinal bleeding or severe intraabdominal bleeding-related hypovolemic shock may also occur. Most of the described cases in prior literature have been reported to use anticoagulant medications. This report describes the second hemorrhagic cholecystitis patient with inherited bleeding diathesis and the first case with Bernard-Soulier syndrome.

Comparison of stimulating dissector and intermittent stimulating probe for the identification of recurrent laryngeal nerve in reoperative setting.

PURPOSE: Recurrent laryngeal nerve (RLN) paralysis is one of the most devastating complications after thyroidectomy. Thyroid reoperation is a great challenge for surgeons due to anatomical distortion and fibrosis and associated with a higher risk of RLN injury. In this study, we aimed to compare stimulating dissector (SD) with intermittent stimulating probe (ISP) in thyroid reoperations. This study is the first one which compares the impact of different nerve stimulating devices in thyroid reoperations. METHODS: Included in this randomized prospective study were patients who had a bilateral subtotal thyroidectomy and would undergo a completion thyroidectomy due to a diagnosis of thyroid papillary cancer between January 2015 and January 2017. Patients were divided into two groups as SD group and ISP group. Age, sex, nerve amplitudes, latencies, the first identification time of RLN and complications were compared in both groups. RESULTS: A total of 32 patients, 16 in both groups, were included in the study. The demographics, nerve signal amplitudes and latencies were similar in both groups (p > 0.05). The mean RLN identification time in the SD group was 17.4 ± 4.3 min, which was significantly shorter than those in the ISP group (mean 21.3 ± 3.9) (p = 0.014). CONCLUSION: The first identification of RLN in the thyroid reoperations was faster with the use of SD than with the use of the ISP. Since the electromyographic amplitudes of RLN and vagus nerve with using SD were similar to the bipolar ISP, SD can be used safely for thyroid reoperations.

Split Sternotomy in Retrosternal Thyroid and Mediastinal Parathyroid Pathologies.

OBJECTIVES: Although cervical incisions are usually sufficient in mediastinal located thyroid and parathyroid pathologies, sometimes mediastinal approaches are required. In recent years, less invasive methods have been used instead of median sternotomy. In this study, the adequacy of the incision and morbidity in patients who underwent split sternotomy due to retrosternal goiter (RG) and mediastinal parathyroid pathology in our clinic were investigated. METHODS: The files of patients who underwent split sternotomy in addition to cervical incision or split sternotomy extending from the sternal notch to the third intercostal space with a separate vertical incision due to retrosternal thyroid pathology or mediastinal ectopic parathyroid adenoma between January 2010 and January 2021 were retrospectively reviewed. Operative success, exposure provided by split sternotomy, and complication rates were investigated. RESULTS: Twelve patients who underwent split sternotomy were included in the study. The mean age of the patients was 57.25±12.62 (44-83) years. Eight (66.7%) of the patients were female and 4 (33.3%) were male. The indication for surgery was multinodular goiter (MNG) in 3 (25%) patients, recurrent MNG in 3 (25%) patients, hyperparathyroidism in 3 (25%) patients, and thyroid cancer in 3 (25%) patients. Transient hypocalcemia in 6 (50%) patients and unilateral vocal cord paralysis in 1 (8.3%) patient developed postoperatively, and all complications resolved spontaneously in an average of 3 weeks. Median sternotomy was not required for any of the patients. CONCLUSION: Split sternotomy is an adequate and applicable method for the success of the surgery in RG and mediastinal parathyroid pathologies that cannot be excised with the cervical approach.

The role of basic blood parameters in determining the viability of intestinal tissue in incarcerated hernias.

OBJECTIVE: Abdominal hernia repair is a common surgery, with incarcerated hernias accounting for 15% of all cases. In these cases, early diagnosis of intestinal ischaemia and necrosis is crucial to prevent mortality and morbidity. Biomarkers that can predict ischaemic or necrotic status are of vital importance. The aim of this study was to reveal the roles of basic blood parameters in determining ischaemic or necrotic status. METHODS: Patients were divided into three groups. Group I included 24 patients with normal bowels, Group II included 31 patients with intestinal ischaemia without necrosis, and Group III included 10 patients who underwent bowel resection for necrosis. Patients' demographic characteristics and blood parameters were retrospectively analysed. RESULTS: A total of 65 patients were operated for incarcerated abdominal hernias. There was no significant difference between the groups in terms of age, sex, comorbidity or complications (P > .05). Group III had the longest length of hospital stay (P < .001). There were significant differences between the groups in terms of serum white blood cell (WBC), neutrophil, lymphocyte (LYM), neutrophil-lymphocyte ratio (NLR), urea, creatinine, total bilirubin, indirect bilirubin, lipase, C-reactive protein (CRP) and lymphocyte-to-C-reactive protein (CRP) ratio (LCR) values (P < .05). CONCLUSION: Blood parameters combining with clinical symptoms and radiological examination may contribute to predicting intestinal resection. Preoperative WBC, neutrophil, NLR, urea, creatinine and total bilirubin levels can contribute to predict the onset of intestinal ischaemia. Serum creatinine, total bilirubin, indirect bilirubin, phosphorus, lactate dehydrogenase (LDH) and lipase levels can contribute to deciding on bowel resection.

Analysis of the Factors Affecting Survival in the Patients who Underwent Curative-Intent Gastrectomy due to Gastric Adenocarcinoma.

OBJECTIVES: Gastric cancer is the fifth most common cancer and the third most common cause of cancer-related deaths in the world. In this study, we aimed to evaluate the impact of clinicopathological factors on overall survival in the patients who underwent curative-intent gastrectomy due to gastric adenocarcinoma. METHODS: The medical records of 644 patients who underwent gastrectomy between January 2007 and January 2017 in our clinic were retrospectively reviewed. Among these patients, 359 patients were included in this study. The impact of several prognostic factors on survival was investigated. RESULTS: The mean age was 59.2±11.6 (29-83). Male/female ratio was 2.12. The median follow-up time was 19 months (CI=10.1-31.1). Median overall survival was 23±2.3 months (CI=18.3-27.6). Splenectomy, R1 (microscopically incomplete) resection, and advanced stage were independent risk factors for poor prognosis. CONCLUSION: R1 resection, splenectomy, and advanced TNM stage were associated with poor prognosis in gastric cancer. Splenectomy should be avoided in the absence of direct invasion of the tumour or metastasis of lymph nodes on splenic hilum to prevent postoperative infectious complication-related mortality.

Duplicated vas deferens: A case report and comprehensive review of the literature.

Duplication of vas deferens is a very rare anomaly which two vasa deferentia are found in the spermatic cord. It can be recognised during autopsy or cadaveric dissection and also several surgical procedures which require spermatic cord dissection including inguinal hernia repair, orchiopexy, vasectomy, varicocelectomy, vasectomy reversal and radical prostatectomy. Recognition of the duplicated vas deferens is important to avoid surgical complications such as an unsuccessful vasectomy or transection of the vas. It was reported in only three cadavers and 31 patients since 1959. In this study, we describe a new case of duplicated vas deferens found incidentally during routine inguinal hernia repair in a 66-year-old patient. We also review all previously reported cases in the literature to draw attention to this rare but important anomaly.

Should there be a specific length of the colon-rectum segment to be resected for an adequate number of lymph nodes in cases of colorectal cancers? A retrospective multi-center study.

OBJECTIVES: This study aimed to evaluate the question as to whether there should be a certain length of the colon-rectum segment to be resected for correct lymph node staging in cases with colorectal cancer. MATERIAL AND METHODS: The files and electronic datas of the patients had been undergone surgery for colorectal cancer between January 2011 and June 2016 were evaluated. The patients were divided into two groups; Group I= ≥ 12 lymph nodes, and Group II= lymph nodes less than 12 ( <12) lymph nodes. RESULTS: Mean age of the 327 participants in this study was 64.30 ± 12.20. Mean length of resected colon-rectum segment was 25.61 (± 14.07) cm; mean number of dissected lymph nodes was 20.63 ± 12.30. Median length of the resected colon was 24 cm (range: 145-6) in Group I and 20 cm (range: 52-9) in Group II; a significant difference was found between the groups (p= 0.002). Factors associated with adequate lymph node dissection included type of the operation (p= 0.001), tumor location (p= 0.005), tumor T stage (p= 0.001), condition of metastasis in the lymph node (p= 0.008) and stage of the disease (p= 0.031). Overall survival was 62.4 ± 1.31 months, and Group I and Group II survival was 61.4 ± 1.39 months and 66.7 ± 3.25 months, respectively (p= 0.449). CONCLUSION: Results of the study showed that ≥ 12 lymph nodes would likely be dissected when the length of the resected colon-rectum segment is > 21 cm. We conclude that the removed colonic size can be significant when performed with oncological surgical standardization.

Torsion of wandering spleen nine years after gastric volvulus: Effect of multiparity?

Wandering spleen is a rare condition and has life-threatening complications, such as torsion or infarction. It may be asymptomatic or may present with chronic abdominal pain or intraabdominal mass. Since clinical diagnosis is usually difficult, radiological examinations play a very important role in diagnosis. A 37-year-old multiparous woman was admitted to the emergency room with a complaint of abdominal pain. The patient stated that she underwent an operation due to gastric volvulus nine years ago. Preoperative diagnosis was made by ultrasonography and computed tomography. Splenectomy was performed because of the irreversible infarction. Wandering spleen torsion is a rare clinical condition that may cause an acute abdomen. Computerized tomography is the gold standard for preoperative diagnosis. Gastric volvulus and wandering spleen have similar etiologies. In the literature, the coexistence of these two diseases in adulthood is rarely reported. However, to our knowledge, this case is the first report to describe the emergence of these two pathologies at different times in adulthood.

Inflammatory myofibroblastic tumour of the colon: 2 case reports and a comprehensive review of the literature.

PURPOSE: Inflammatory myofibroblastic tumour (IMT), which is also named as plasma cell granuloma (PCG) or inflammatory pseudotumour (IPT), is a rare tumour which rarely develops in the colorectal region. We aimed to review all reported cases to draw attention about this rare tumour. METHODS: We present two new cases of colonic IMT with no recurrence during the follow-up period. We also reviewed previously reported colorectal IMT/IPT/PCG patients to investigate demographics, diagnosis and treatment modalities. RESULTS: A total of 60 patients which including our 2 patients and 58 patients from 42 published articles were analysed. Male/female ratio was 34/26. Mean age was found to be 31.84 ± 22.26 years (9 months-82 years). Abdominal pain (56.7%) and fever (23.3%) were the most common complaints in the first admission. Fifty-nine (98.3%) out of 60 patients underwent surgery. During follow-up, 7 (14.3%) patients developed a local recurrence. CONCLUSION: IMT may occur at any age. IMT is considered to be a borderline tumour with the potential for recurrence or distant metastasis. Complete resection of the tumour is recommended for treatment. Long-time follow-up is necessary due to recurrence potential of the tumour even many years after complete surgical resection. TRIAL REGISTRATION: The study follows the regulation of the Institutional Review Board for human research at Izmir Katip Celebi University Ataturk Training and Research Hospital. Written informed consents were obtained from the patients who participated in this study.

A Rare Complication of Anticoagulant Therapy: Intramural Hematoma of the Small Bowel.

BACKGROUND: Non-traumatic intramural hematomas of the small bowel (IHSB) are rare conditions which occur due to anticoagulant therapy. In this study, we aimed to explain our clinical approach to non-traumatic IHSB due to anticoagulant overdose and to present the long-term outcomes of the cases who were hospitalized. METHODS: Sixteen patients with non-traumatic IHSB were included and their medical records were retrospectively reviewed. RESULTS: Our patients included ten women and six men, with a mean age of 77.5 ± 8.4 (range: 65-95) years. All patients had been using oral anticoagulants (OACs) due to various cardiovascular and cerebral comorbidities. Common complaints at the time of admission included abdominal pain, vomiting and weakness. Ten patients (62%) had anemia, fifteen (94%) had leukocytosis and all patients (100%) had high levels of C-reactive protein (CRP). Abdominal computed tomography (CT) established the final diagnosis of IHSB in all patients. Fourteen patients (87%) were followed up with conservative therapy. Since the clinical course did not improve in two patients (12%), surgery was mandated. The mean duration of hospitalization was 10.25 ± 3.6 days (range: 3-17 days). Mortality occurred in two patients (12%). CONCLUSION: IHSB should be considered in patients presenting with abdominal complaints and increased levels on coagulation tests. The diagnosis should be confirmed by abdominal CT scan, if possible. Accurate and timely diagnosis allows patients to be successfully treated without need for surgery.

Carcinoma Showing Thymus-Like Elements: A Rare Malignant Tumor of the Thyroid Gland.

Carcinoma showing thymus-like elements (CASTLE) is a rare tumor arising in the thyroid gland. Fewer than 100 patients with this tumor, those predominantly from Eastern Asia, have been reported before. We present the first CASTLE case from Turkey. A 51-year-old male was admitted with a complaint of a neck mass and hoarseness. A laryngoscopic examination revealed left vocal cord paralysis. Neck ultrasonography showed a tumor which was compressing the esophagus and had invaded the left recurrent laryngeal nerve (RLN). The patient underwent a total thyroidectomy, a unilateral central-compartment neck dissection, and following adjuvant radiotherapy. Intraoperative nerve monitoring was performed during the operation to preserve the contralateral nerve. He completed a 3-year follow-up period after the completion radiotherapy, and no recurrence was observed. The treatment is controversial, although surgery with or without adjuvant radiotherapy appears to be the best choice. In cases of RLN destruction due to tumor invasion, we recommend using intraoperative nerve monitoring to preserve the contralateral RLN to avoid devastating complications, such as a tracheostomy.

Multifocality related factors in papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinoma (PTC) is the main type of the well-differentiated thyroid carcinomas. Multifocality is regarded as a poor prognostic factor for PTC. METHODS: Documents of 777 patients who underwent thyroidectomy were reviewed retrospectively. A total of 305 PTC patients were included. Patients with multifocal PTC were included in Group 1, and patients with unifocal PTC were included in Group 2. RESULTS: There were 165 patients (54.0%) in Group 1 and 140 patients (46%) in Group 2. The pathological mixed variant of PTC was significantly higher in Group 1 (p = 0,005). Lymph node metastasis (LNM) was detected at 9.6% and 3.5% in Group 1 and Group 2, respectively (p = 0,028). Micro PTC rates were 28.4% and 40.7% in Group 1 and Group 2, respectively (p = 0,017). Tumor size and pathologically mixed-type and fine-needle aspiration biopsy (FNAB) results were significantly different between multifocal and unifocal Micro PTC (p < 0.05). CONCLUSIONS: Multifocality is more frequent in patients with tumors ≥1 cm and mixed-type tumors. LNM is found more often in multifocal tumors. The presence of micropapillary tumors can be predicted preoperatively by ultrasound-guided FNAB. Mixed-type pathology is also a predictive factor for multifocality.

Minimally invasive parathyroidectomy using intraoperative ultrasonographic localization for primary hyperparathyroidism in pregnancy: report of two cases.

Primary hyperparathyroidism (pHPT) in pregnancy is a rare entity associated with increased maternal and fetal mortality and morbidity. Diagnosis of pHPT is challenging in pregnancy. Approximately 80% of the cases are asymptomatic, while the most common symptoms are nausea, vomiting, polyuria, polydypsia, and cloudy vision in symptomatic patients. Since the most common cause of pHPT in pregnancy is adenoma, such in the general population, focused anterior or lateral approach is recommended due to shorter operation time, less risk for the fetus, and lower complication risk. Performing intraoperative ultrasonography to do the incision just over the adenoma provides quicker access to the adenoma and intraoperative parathormone assay confirms the surgical cure. Laryngeal mask anesthesia causes lesser sore throat, laryngospasm, coughing, and rapid recovery as compared to endotracheal intubation anesthesia. This study aimed to present the management of two pregnant patients diagnosed with pHPT and who underwent minimally invasive parathyroidectomy under intraoperative ultrasonography and laryngeal mask anesthesia at the second trimester of gestation. To the best of our knowledge, parathyroidectomy under laryngeal mask anesthesia in pregnancy has never been described before.

Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection.

OBJECTIVES: Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival. METHODS: A total of 63 patients with tumor invasion stage T1a or T1b who were operated on for early GC between 2010 and 2018 were included in the study. Parameters were investigated retrospectively to identify predictive factors for LNM and overall survival. Significance was defined with a 2-sided p-value of <0.05. RESULTS: Among the 63 patients, 21 (33.3%) had LNM. Lymphovascular invasion (LVI) (p=0.02) and a high-grade tumor (p=0.02) were significantly associated with LNM. The overall survival rate was 73.0%. The number of patients with LNM was greater among the deceased patients compared with the censored group (p=0.03). The median follow-up time of the entire group was 28 months (range: 12-55 months) while it was 23 months (range: 7-39 months) in the deceased group and 33.5 months (15.5-60 months) in the censored group (p=0.06). The mean survival was 62.36 months in patients with LNM and 71.99 months in those without LNM (p=0.09). The cut-off value determined for the neutrophil-to-lymphocyte ratio (NLR) was 2.33 and it was an effective value in survival analysis (p<0.05). CONCLUSION: Surgical treatment should be considered for early GC patients with high-grade tumors and cases demonstrating LVI. The overall survival was shorter in patients with a high NLR value and LNM.

Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases.

INTRODUCTION: The term multiple primary tumor (MPT) is used to describe cases where two or more primary tumors show no histopathological similarities in between. Multiple primary tumor cases have begun to increase in recent years as a result of the increase in life expectancy because of the increase in life standards and progress in diagnostic methods. In this study, MPT cases with periampullary tumors that underwent Whipple procedure were discussed in the light of literature data. MATERIALS AND METHODS: The patient files of 223 cases with periampullary tumors that underwent Whipple procedure in our hospital during the last 6 years were examined retrospectively. More than one primary tumor was detected in 21 patients. RESULTS: Periampullary carcinomas were detected as a second primary tumor in 18 patients. First primary tumor was periampullary carcinoma in 3 patients that underwent Whipple procedure. After the Whipple procedure, 5 patients died due to early complications in the first 30 days and 6 patients died due to metastases and additional problems that developed during follow-up. DISCUSSION: The incidence of MPT has been reported as 0.7 to 14.5% in the literature. Most of them are multiple primary case presentations. In patient management, it is recommended that each tumor should be evaluated independently of its own characteristics, and treatment and follow-up should be planned accordingly. CONCLUSION: The MPT cases are increasing. The possibility of MPT as well as metastasis should be kept in mind during the evaluation of tumor foci seen during diagnosis and follow-up of patients. The characteristics of each tumor, survival, and prognosis should be evaluated separately and the most appropriate treatment should be offered to the patient. It is recommended that synchronic primary tumors which are considered to be surgically resectable without metastasis should be removed in the same session.How to cite this article: Dilek ON, Ozsay O, Karaisli S, Gür EÖ, Er A, Haciyanli SG, Kar H, Dilek FH. Striking Multiple Primary Tumors that underwent Whipple Procedure due to Periampullary Carcinoma: An Analysis of 21 Cases. Euroasian J Hepato-Gastroenterol 2018;8(1):1-5.

Hydatid cyst of the pancreas causing both acute pancreatitis and splenic vein thrombosis.

Hydatid cyst of the pancreas is a rarely seen entity even in endemic countries. Cyst may causes several symptoms due to external compression or fistulisation to pancreaticobiliary tract or small bowel. A 23-year-old female patient was referred with a complaint of abdominal pain. Preoperative imaging revealed an undefined cyst in the tail of pancreas. She underwent distal pancreatectomy and splenectomy, with a diagnosis of acute pancreatitis due to cystopancreatic duct fistula and also left-sided portal hypertension due to splenic vein thrombosis. Pathological examination reported a final diagnosis of hydatid cyst. To the best of our knowledge, coincidence of cystopancreatic duct fistula and splenic vein thrombosis due to pancreatic hydatid cyst has not previously been reported.