Extracción endoscópica por CPRE de Fasciola hepática viva: reporte de dos casos y revisión de la literatura / Endoscopic removal by ERCP of Fasciola hepatica alive: two cases report and review of the literature

Presentamos dos casos de fascioliasis crónica en pacientes procedentes de la zona andina del Perú, con sintomatología de varios meses de evolución, con dolor tipo biliar, coluria e ictericia en uno de los casos. Ambos referidos al Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen para estudio por sospecha de colédocolitiasis. Se les realizó exámenes de laboratorio que mostraban aumentos variables en las pruebas de función hepática (colestasis) y en uno de ellos eosinofilia marcada. Se realizó colangioresonancia magnética (CRMN) en ambos casos demostraron imagen sugestiva de cálculo en colédoco. La pancreatocolangiografía retrograda endoscópica (CPRE) fue realizada y luego de esfinterotomía, se extrajo un parásito aplanado, lanceolado, con movilidad activa morfológicamente compatible con Fasciola hepática en ambos casos. Posterior a la CPRE se inició tratamiento antiparasitario con triclabendazol, siendo la evolución clínica favorable.

We report two cases of biliary fascioliasis in patients from the highlands of Peru; with several months of symptoms characterized for biliary-type pain, dark urine and jaundice in one case. Both of them referred to the department of Gastroenterology of the Hospital Nacional Guillermo Almenara Irigoyen for suspicious of choledocolithiasis. Laboratory tests were performed which showed variable high levels of functional liver tests (cholestasis) and marked eosinophilia in one case. Magnetic resonance cholangiography (CRMN) was performed and then informed as an apparent image of biliary stone in choledocus in both cases. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and after sphincterotomy, one flattened, lanceolate parasite, with active mobility morphologically compatible with Fasciola hepatica was extracted. After the ERCP antiparasitic treatment was given with triclabendazole. Clinical outcome was favourable.

Fasciola Hepatica worm swims in the gallbladder

Human infestation with liver flukes is rare, as they are accidental host by ingestion of contaminated water and vegetables. To document the presence of this disease in Iraq/ Kurdistan region, we are reporting this case of Fasciola Hepatica infestation to a young lady with recurrent attacks of Rt. Abdominal pain. The worm was found, during cholecystectomy, swimming in the bile of gallbladder

Parásitos de fasciola hepática intracoledociano / Common bile duct fasciolasis: report of one case

La fasciolasis es una enfermedad parasitaria producida por el tremátodo digeneo Fasciola hepática. Durante la fase crónica de la enfermedad los parásitos pueden entran en los conductos biliares, y ser causa de ictericia obstructiva, colangitis, pancreatitis y otras complicaciones. Se presenta el caso clínico de una paciente intervenida por sospecha de colelitiasis y colédocolitiasis, a la cual durante la exploración coledociana intraoperatoria le fueron extraídos múltiples parásitos adultos de Fasciola hepática. Este hallazgo sólo fue aclarado posteriormente en la biopsia diferida. Se realiza una revisión breve del tema, métodos de diagnóstico, tratamiento médico y alternativas quirúrgicas de tratamiento.

Fasciolasis is a zoonotic disease caused by the digenean trematode Fasciola hepatica. During the chronic phase of the disease the parasites invade the main biliary ducts, causing obstructive jaundice, cholangitis, pancreatitis and other complications. We report a 75 years old female, operated due to the suspicion of a choledocholithiasis. During the exploration of the choledochus, adult F. hepatica parasites were extracted. The pathology report of the parasites confirmed the diagnosis.

Hematoma hepático por fascioliasis / Hepatic hematoma caused by fascioliasis

The clinical presentation of two patients was carried out, with the history of having consumed in their diet watercress, and presented digestive and general symptoms. One of the patients presented hepatomegalia; but both presented jaundice and eosinophilia; CAT scan was suggestive in both cases of the presence of hepatic hematomas, confirmed by laparoscopic study and surgical intervention. The definitive diagnosis of hepatic hematoma by fasciolasis was obtained during the operation and the postoperative study, added to the other important complementary exams in this entity.