88 Bombay Hospital Journal, Vol. 51, No. 1, 2009 Introduction P rimary hydatid cyst of the pancreas is rare, during the last 30 years, less than 40 cases have been reported in journals on Medline. 1 Hydatidosis is an endemic disease caused by the Echinococcus granulosus. The eggs of the worm being excreted in the infected dogs faeces. Intermediate hosts usually are cows, sheeps, pigs, whereas human beings are accidental intermediate hosts. After hatching in jejunum, larvae enters portal system through intestinal mucosa. Final destination in 50% cases being liver followed by lungs, spleen, bone and brain; very rarely breast, muscles and pancreas. Diagnosing hydatid cyst of pancreas pre- operatively is difficult due to its rarity. Computed tomography (CT) scan is helpful in identifying presence of multiloculation, curvilinear calcification or presence of daughter cysts. However final diagnosis can only be done by surgical exploration and histopathologic examination. Case Report A 21 year old male was referred to us with history of gradual abdominal distension since 2 years. There was no history of pain, any bowel or urinary complaints. Patient had no past history of tuberculosis. Examination revealed a large, non tender lump occupying majority of the upper abdomen. Ultrasonography was suggestive of a large multiloculated cystic swelling, but it could not exactly define the origin of swelling. Computed tomography (CT) scan of abdomen and pelvis showed a very large cystic swelling which was below left lobe of liver and behind stomach, anterior to pancreas measuring 35 cms X 20.8 cms X 10.5 cms, with presence of daughter cyst (Fig. 1). Bowel was displaced to right side of abdomen (Fig. 2). Diagnosis of pancreatic or retroperitoneal hydatid cyst was given. Midline transperitoneal exploration revealed a large cyst in lesser sac adherent to omentum, transverse mesocolon, and posterior wall of stomach, A scolicidal agent, 3% cetrimide was first introduced and then the cyst was opened, germinative membrane and daughter cysts were seen (Fig. 3) and removed. Cyst was then dissected from surrounding structures and was found to be originating from pancreatic body (Fig. 4). There was no communication with main pancreatic duct (MPD). Sub-total cystectomy was performed leaving only layer of adventia on pancreatic body and the cyst cavity was obliterated with a patch of the omentum. Post-operative course was uneventful, 6 months course of Albendazole was given. Follow-up after 1 year has shown patient to be symptom and disease free. *Lecturer; **Associate Professor; ***Professor and Unit Head; Department of General Surgery, Grant Medical College, Sir J J Group of Hospitals, Mumbai - 400 008. Hydatid Cyst of Pancreas Ashok D Borisa*, Girish D Bakhshi**, Mukund B Tayade***, Narendra H Pawar*, Narendra N Nikam*, Satyajeet Pathrikar* Abstract Although India being endemic country for hydatid disease, primary pancreatic hydatid cyst seems to be rarity. Pancreatic hydatid are most often confused with cystic lesions of the pancreas and pancreatic pseudocyst. Diagnosis of hydatid cyst of the pancreas can be confirmed only by surgical exploration and histopathology. The presentation and related literature is discussed.