RESUMO
BACKGROUND: We examined the impact of the Clonorchis sinensis (C. sinensis) infection on the survival outcomes of spontaneous rupture Hepatocellular Carcinoma (srHCC) patients undergoing hepatectomy. METHODS: Between May 2013 and December 2021, 157 consecutive srHCC patients who underwent hepatectomy were divided into an no C. sinensis group (n = 126) and C. sinensis group (n = 31). To adjust for differences in preoperative characteristics an inverse probability of treatment weighting (IPTW) analysis was done, using propensity scores. Overall survival (OS) and recurrence-free survival (RFS) were compared before and after IPTW. Multivariate Cox regression analysis was performed to determine whether the C. sinensis infection was an independent prognostic factor after IPTW. RESULTS: In original cohort, the no C. sinensis group did not show a survival advantage over the C. sinensis group. After IPTW adjustment, the median OS for the C. sinensis group was 9 months, compared to 29 months for the no C. sinensis group. C. sinensis group have worse OS than no C. sinensis group (p = 0.024), while it did not differ in RFS(p = 0.065). The multivariate Cox regression analysis showed that C. sinensis infection and lower age were associated with worse OS. CONCLUSIONS: The C. sinensis infection has an adverse impact on os in srHCC patients who underwent hepatectomy.
Assuntos
Carcinoma Hepatocelular , Clonorquíase , Clonorchis sinensis , Neoplasias Hepáticas , Humanos , Animais , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/patologia , Ruptura Espontânea/cirurgia , Ruptura Espontânea/complicações , Prognóstico , Pontuação de Propensão , Clonorquíase/complicações , Clonorquíase/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Hepatic clonorchiasis is one of the most prevalent food-borne parasitic diseases worldwide. Clonorchis sinensis, the pathogen, is the major parasitic trigger contributing to cholangitis, cholelithiasis, and even cholangiocarcinoma. Unfortunately, unspecific clinical manifestations of patients with hepatic clonorchiasis tend to mislead clinicians to neglect or misdiagnose them, following ignorance of appropriate therapy. Our case report may shed light on definite diagnosis of clonorchiasis with concomitant cholelithiasis, methodology for surgical drainage of the parasites, and postoperative anthelmintic therapy. CASE PRESENTATION: Two patients with habit of eating infected raw or undercooked freshwater fish were hospitalized due to right upper quadrant pain and jaundice. Magnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) detection indicated cholangiolithiasis and cholangiolithiasis with concurrent cholecystolithiasis, respectively. Fecal examinations were both negative for adult worms or eggs of parasites. However, adults of Clonrochis sinensis were detected within hepatobiliary tracts during laparoscopic cholecystectomy. Postoperative drainage and anthelmintic therapy contributed to complete recovery with good prognosis. CONCLUSIONS: Clonorchiasis provokes cholangiolithiasis and cholecystolithiasis. Standardized treatments for these gallstone patients with concomitant clonorchiasis include surgical removal of the calculus, postoperative T tubule drainage and anthelmintic therapy. Serological test or polymerase chain reaction (PCR)-based approaches might be helpful for diagnosis of clonorchiasis when no eggs are found by stool microscopy. Public health promotion on ceasing to eat raw freshwater fish is essential for prevention and control of clonorchiasis.
Assuntos
Sistema Biliar/diagnóstico por imagem , Sistema Biliar/parasitologia , Colangiopancreatografia por Ressonância Magnética/métodos , Clonorquíase/diagnóstico , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/parasitologia , Laparoscopia/métodos , Adulto , Animais , Anti-Helmínticos/uso terapêutico , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/parasitologia , Colecistectomia Laparoscópica , Clonorquíase/complicações , Clonorquíase/tratamento farmacológico , Clonorquíase/cirurgia , Clonorchis sinensis/isolamento & purificação , Feminino , Cálculos Biliares/diagnóstico , Cálculos Biliares/tratamento farmacológico , Cálculos Biliares/parasitologia , Cálculos Biliares/cirurgia , Humanos , Icterícia Obstrutiva/tratamento farmacológico , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
This case report describes an unusual presentation of Clonorchissinensis infection. In this rare case, a clonorchiasis infection that had been latent for decades was misdiagnosed as acute calculous cholecystitis.Exploratory surgery and a cholecystectomy were performed. Therefore,in the course of diagnosis of hepatic and gall diseases, we cannot neglect parasite infections such as clonorchiasis.
Assuntos
Colecistectomia , Clonorquíase/diagnóstico por imagem , Clonorquíase/cirurgia , Erros de Diagnóstico , Procedimentos Desnecessários , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaAssuntos
Clonorquíase/diagnóstico , Idoso de 80 Anos ou mais , Animais , Anti-Helmínticos/uso terapêutico , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Clonorquíase/tratamento farmacológico , Clonorquíase/cirurgia , Clonorchis sinensis/isolamento & purificação , Ducto Colédoco/diagnóstico por imagem , Humanos , Masculino , Praziquantel/uso terapêutico , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Clonorchiasis is caused by a chronic infestation of liver flukes, Clonorchis sinensis, and these reside mainly in the medium- and small-sized intrahepatic bile ducts. Therefore, diffuse, uniform, minimal or mild dilatation of these bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct is the typical finding on several imaging modalities. We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.
Assuntos
Clonorquíase/diagnóstico por imagem , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/parasitologia , Tomografia Computadorizada por Raios X/métodos , Animais , Clonorquíase/cirurgia , Diagnóstico Diferencial , Humanos , Abscesso Hepático/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.
Assuntos
Colecistite/etiologia , Colecistite/patologia , Colecistite/parasitologia , Clonorquíase/complicações , Clonorchis sinensis , Adulto , Animais , Ductos Biliares/parasitologia , Colecistectomia , Colecistite/tratamento farmacológico , Clonorquíase/cirurgia , Hong Kong , Humanos , Masculino , Praziquantel/uso terapêuticoRESUMO
Nine cases of acute pancreatitis due to parasites in the common bile duct (Ascaris lumbricoides 4, Clonorchis sinensis 5) are reported. Eight cases were discovered at laparotomy and one at postmortem. The indications for operation were worsening pancreatitis, sepsis or cholangitis. Decompression of the biliary system and removal of parasites resulted in the recovery of the eight cases operated upon. In endemic areas, all patients with acute pancreatitis should be screened for parasites. Antibiotics and/or antihelminthics should be given if they are found. Surgery is necessary for those with worms causing biliary or pancreatic obstruction who do not respond.
Assuntos
Ascaríase/complicações , Clonorquíase/complicações , Doenças do Ducto Colédoco/complicações , Pancreatite/etiologia , Doença Aguda , Adulto , Idoso , Ascaríase/cirurgia , Ascaríase/terapia , Clonorquíase/cirurgia , Clonorquíase/terapia , Doenças do Ducto Colédoco/cirurgia , Doenças do Ducto Colédoco/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/cirurgia , Pancreatite/terapiaRESUMO
The syndrome of Oriental cholangiohepatitis is characterized by helminthiasis, choledocholithiasis often without cholecystolithiasis, biliary duct stricture and hepatic abscess. The common duct stones are usually multiple, black and friable. Fourteen cases have been seen in recent immigrants to the United States. Thirteen patients had choledocholithiasis, and 1 had viable flukes in the ducts. Choledochoenterostomy is usually required because of multiple stones, including intrahepatic stones, or proven or presumed infestation with Clonorchis sinensis. The latter, the Chinese liver fluke, is an infestation for which medical therapy does not exist. Resection, particularly of the lateral segment of the left hepatic lobe, may be required in cases of abscess and stones associated with stricture of the left hepatic duct.
Assuntos
Colelitíase/cirurgia , Colestase/cirurgia , Clonorquíase/cirurgia , Adulto , Idoso , Ascaris/parasitologia , China , Colelitíase/diagnóstico , Colelitíase/diagnóstico por imagem , Colelitíase/parasitologia , Colestase/diagnóstico , Colestase/diagnóstico por imagem , Colestase/parasitologia , Clonorquíase/complicações , Clonorchis sinensis/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , SíndromeRESUMO
Clonorchis sinensis has a minor incidence in Western countries and most commonly manifests as cholangiohepatitis with secondary bacterial infection. This parasite rarely obstructs the common bile duct without associated biliary stricture, stones or tumor. This paper documents the fourth reported case of acalculous C, sinensis biliary tract obstruction and reviews the world literature.