Background Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stage of Echinococcus granulosus. The liver is the organ most commonly affected, whereas pancreatic involvement is extremely rare. When a patient with recurrent hepatic CE also presents with a pancreatic cystic lesion, accurate preoperative diagnosis can be difficult because the imaging findings may overlap.Case presentation: A 36-year-old woman with a history of surgery for hepatic hydatid disease presented with intermittent right upper abdominal pain for 1 month. Serologic testing was positive for Echinococcus granulosus IgG. Imaging showed multiple hepatic cystic echinococcosis lesions classified as CE2, CE4, and CE5, together with a 16 mm cystic lesion in the body of the pancreas. The pancreatic lesion had a well-defined border, showed no contrast enhancement, and could not be clearly characterized before surgery. Pancreatic echinococcosis therefore could not be excluded. The patient underwent right hepatectomy, common bile duct exploration, and cholecystectomy. During surgery, the pancreatic lesion was examined, but it did not show typical features of hydatid disease. Pancreatic echinococcosis was considered unlikely, and no pancreatic resection was performed. Postoperative pathology confirmed hepatic cystic echinococcosis. The patient recovered well, and follow-up CT at 1 month showed reduced postoperative inflammatory changes in the surgical area, while the pancreatic cystic lesion remained stable in size without significant change.Conclusions In endemic areas, careful differential diagnosis is essential when recurrent hepatic cystic echinococcosis is accompanied by a pancreatic cystic lesion. In this setting, intraoperative assessment combined with postoperative imaging follow-up may support safe clinical management while helping to avoid unnecessary pancreatic resection.