A Rare Cause of Biliary Obstruction Caused by Egg of Fasciola Hepatica Mimicking Biliary Duct Stone or Rupture of Liver Hydatid Cyst - Abstract
Fasciola hepatica is an endemic parasitic disease in Iran and some countries in the world. The humans are accidentally infected by Fasciola in the life cycle. The definitive host is sheep. When human infected, The presentations are in two shape: acute or hepatic and chronic or biliary shape. When the flukes or eggs enter the bile ducts, cholestasis and cholangitis may present. These complications can be misdiagnosed from other cause of obstructive jaundice especially biliary stones. We present cases of fascioliasis, which present with sever colicky abdominal pain, jaundice and fever and was difficult to differentiate from gallstone or ruptured hydatid cyst in this patient. A 52-year-old man from north of Iran with history of hydatid cyst of liver, presented with severe colicky abdominal pain, fever, right upper quadrant pain and jaundice. Total bilirubin was 6 mg/dl, Direct bilirubin was 4 mg/dl ,aspartate aminotransferase 65 IU/L, alanine aminotransferase 75 IU/L, alkaline phosphatase 525 IU/L, .WBC =1400O with 40% eosinophilia .U&S show distended and edematous gallbladder wall and CBD diameter was 12 mm without stone. MRCP showed distention of gallbladder and filling defect and obstruction in the distal portion of CBD. ERCP with sphenctrommy was performed and multiple eggs were removed from the choledochus. The result of an indirect hemagglutination test for F. hepatica was 1/286 .General condition of patient was improved day to day. In conclusion: The chronic phase of fasciola hepatica infection can be misdiagnosed as multiple other cause of obstructive jaundice. Thus, in endemic areas F. hepatica and hydatid cyst should be in the differential diagnosis of common bile duct obstruction and jaundice, MRCP and ERCP can help to diagnosis and treatment.