An unusual case of biliary obstruction caused by Dicrocoelium dentriticum.

Dicrocoelium dentriticum (D. dentriticum) is a liver fluke induced biliary obstruction. Infection usually occurs in herbivores such as sheep, goats and deer; human infection is very rarely encountered in clinical practice. We report on a 65-y-old female presenting with biliary obstruction caused by D. dentriticum. Following treatment with triclobendazole, her symptoms disappeared, and laboratory values returned to normal range within 6 months. Parasitosis is an important cause of biliary obstruction. We suggest that for patients presenting with biliary obstruction, D. dentriticum should be included in the differential diagnosis.

Common bile duct obstruction caused by the hydatid daughter cysts.

Echinococcosis is a human parasitary disease. In 2002, 29 new cases of liver echinococcosis were recorded in Croatia. Liver is the most common site of hydatid cysts. Nine patients with echinoccocal liver disease were operated in our department in 2002. Here we present a case where a patient with verified hydatid cyst in the left liver lobe developed high fever, jaundice, nausea, vomiting and pain in the upper abdomen. The symptoms were initially ascribed to the acute cholangitis. After unsuccessful antibiotic treatment, computerized tomography and endoscopic retrograde cholangiopancreatography (ERCP) were performed, demonstrating daughter cysts in the common bile duct. During ERCP, papilotomy was made and daughter cysts were extracted. Hydatid cyst was surgically removed, and a communication between the cyst and left hepatic duct was noted during surgery. Pericystectomy, choledochotomy, removal of remaining daughter cysts from the common bile duct, and sutures of left hepatic duct were performed. The patient recovered fully after the surgery. One of the possible complications of the liver hydatid cysts is the communication between cyst and the biliary tree. Such communications are usually asymptomatic, but symptoms can also mimic acute cholangitis and jaundice, which may lead to the misdiagnosis of the patient's condition.

Obstructive jaundice caused by primary choledochal hydatid cyst mimicking radiologically choledochal cyst.

A 12-year-old girl with obstructive jaundice that was initially misinterpreted radiologically as having choledochal cyst is presented. A primary hydatid cyst in the wall of the common bile duct causing obstruction was found at operation. The authors emphasize that hydatid cyst should be included in the list of differential diagnoses of obstructive jaundice and cystic lesions located around the biliopancreatic junction in children.

Biliary ascariasis: CT, MR cholangiopancreatography, and navigator endoscopic appearance--report of a case of acute biliary obstruction.

A case of acute common bile duct obstruction caused by a roundworm in a 6-year-old girl is reported. Computed tomography (CT) and magnetic resonance imaging (MRI) showed "bull's-eye" and "eye-glass" appearances of the ascaris in the common bile duct. On reformation of the transverse CT and coronal MR images, the tubular Ascaris was better depicted. MRI and navigator endoscopic demonstrations of the common bile duct ascaris have not been described previously in the literature. These CT and MRI findings may be helpful in the diagnosis of Ascaris.

[Obstructive jaundice caused by hydatid cyst rupture in main bile duct]. / Ittero ostruttivo da rottura di cisti idatidea nella via biliare principale.

Hydatid hepatic cyst rupture into bile duct is a complication of hydatid disease. The rupture is more frequent in right or left epatic duct and occasionally in common bile duct (7-9%). A 50-year old man came to emergency room owing to jaundice, fever and abdominal pain. TC show an hydatid cyst with daughter's cyst of left liver and dilatation of biliary tree. Laboratory data of significance included an increased of liver function tests (Bilirubin, Alkaline ph., SGOT, SGPT), VES and leukocytosis. The patients was surgically treated, by total pericystectomy, colecystectomy and coledocotomy with lavage o common bile duct; finally we placed one Kehr drainage and two abdominal drainage. After 15 days of postoperative hospitalization patient was discharged. The best treatment of hydatid cyst is total pericystectomy (when possible). An alternative surgical treatment is possible for the presence of communication with biliary tree. ERCP is very important for a correct diagnosis and for a complete surgical treatment.

Acute cholecystitis and cholangitis caused by Echinococcus granulosus.

We report for the first time in the recent North American literature, the case of a patient with rupture of a hepatic hydatid cyst into the gallbladder, with subsequent obstruction of the cystic duct by a daughter cyst acting as a ball-valve and causing acute acalculous cholecystitis.

The role of sonography in the early diagnosis of biliopancreatic Ascaris infestation.

Acute pancreatitis due to ascaris lumbricoides infestation is extraordinarily uncommon in Europe. The diagnosis can be difficult because of the low index of suspicion in our area, and this may lead to death. The case of a Columbian patient living in Spain who developed an acute pancreatitis is discussed. He had no history of alcohol abuse, gallstones, or drug abuse. The sonography showed a longitudinal structure with inner parallel linear bands and undulant movements inside the gallbladder and a hypoechogenic pancreas. These features are compatible with acute pancreatitis secondary to Ascaris lumbricoides infestation. The patient was treated with mebendazole and his evolution was excellent. Sonography was useful as an assessment modality during follow-up. We conclude that Ascaris lumbricoides should be recalled as a rare cause of acute pancreatitis in Western countries. Sonography allows early diagnosis and prompt treatment.

Biliary complications of Fasciola hepatica: the role of endoscopic retrograde cholangiography in management.

The parasite Fasciola hepatica resides in the biliary tree but rarely causes significant clinical sequelae. In this report, we review our experience with four patients in whom F. hepatica infection resulted in biliary complications, especially severe biliary colic and jaundice. The diagnosis was achieved with endoscopic retrograde cholangiography which demonstrated the worms in the extrahepatic bile ducts. Endoscopic sphincterotomy was performed uneventfully in all patients allowing balloon extraction of the parasites and resolution of their symptoms.

[Obstruction of the principal bile duct caused by Fasciola hepatica. First case in Sicily]. / Ostruzione della via biliare principale da fasciola epatica. Prima osservazione in Sicilia.

The first case of human liver infestation due to liver fluke in Sicily is reported. After a clinical review of parasitosis, the autochthonous nature of the case is mentioned to highlight its epidemiological and prophylactic importance, especially in those regions where climatic conditions and living and working habits favour infestation. Finally, attention is called to diagnostic difficulties, treatment and appropriate hygiene and dietetic measures.

[Extrahepatic obstructive jaundice caused by Fasciola hepatica]. / Ictero obstructivo extraepático por Fasciola hepatica.

A 58 year old female patient with diabetes manifested 30 years ago is reported. She had digestive disorders since 20 years ago, and a diagnosis of cholecystopathy had been established. Furtherly, she had jaundice, acholia and pruritus; this picture remitted spontaneously. During the next year she had again jaundice, epigastric pain and vomitings; this picture also remitted with home rest. Fifteen days prior to her admittance she had again jaundice, epigastralgia extending to the back, vomitings and pruritus, as well as a diabetic uncontrol. She was admitted though bile ducts were not roentgenographically explored as a result of iodine allergy. A Fasciola hepatica was intraoperatively found.