Total rupture of hydatid cyst of liver in to common bile duct: a case report.

Rupture of hydatid liver cyst into biliary tree is frequent complications that involve the common hepatic duct, lobar biliary branches, the small intrahepatic bile ducts,but rarely rupture into common bile duct. The rupture of hydatid cyst is serious life threating event. The authors are reporting a case of total rupture of hydatid cyst of liver into common bile duct. A 50-year-old male patient who presented with acute cholangitis was diagnosed as a case of totally rupture of hydatid cyst on Abdominal CT Scan. Rupture of hydatid cyst of liver into common bile duct and the gallbladder was confirmed on surgery. Treated by cholecystectomy and T-tube drainage of Common bile duct.

A rare cause of obstructive jaundice: Fasciola hepatica mimicking cholangiocarcinoma.

Fasciola hepatica is an endemic zoonotic disease in Turkey and neighboring countries. The usual definitive host is the sheep; humans are accidental hosts in the life cycle of the Fasciola. There are two disease stages: the hepatic (acute) and biliary (chronic) stages. When the flukes enter the bile ducts, the symptoms of cholestasis and cholangitis may present, which can easily be misdiagnosed as obstructive jaundice of other causes. We present a case of fascioliasis, which was difficult to differentiate from cholangiocarcinoma. A 47-year-old woman from Eastern Turkey presented with fever, right upper quadrant abdominal pain, and jaundice. Total bilirubin was 4.2 mg/dl, aspartate aminotransferase 55 IU/L, alanine aminotransferase 65 IU/L, alkaline phosphatase 325 IU/L, and gamma-glutamyl transpeptidase 172 IU/L. All tumor markers including carcinoembryonic antigen and Ca19-9 were in normal values. After extended evaluation, an explorative laparotomy with cholecystectomy, choledochostomy and T-tube drainage was performed. Multiple flukes were removed from the choledochus. One of the parasites was sent to the parasitological clinic for identification. The result of an indirect hemagglutination test for F. hepatica was 1/320 (+). In conclusion, the chronic phase of this zoonotic infection can be easily misdiagnosed as any other cause of obstructive jaundice. Thus, F. hepatica should be considered in the differential diagnosis of common bile duct obstruction, especially in endemic areas.

[Hydatid acute pancreatitis]. / Hidatik Akut Pankreatit.

Liver hydatid cysts are known to rupture into the biliary tree, but acute pancreatitis is a rare complication of intra-biliary rupture. Intra-biliary rupture was first reported in 1928 by Dew. Intra-biliary rupture is a serious complication of hepatic hydatid cysts. The incidence varies from 1% to 25% in adult patients. In our case, we aimed to show the migration of the material of a hepatic hydatid cyst to the common bile duct and the impaction of hydatid membrane in the papillary orifice, which may cause acute pancreatitis. Parasitic infections should be considered as a differential diagnosis in patients with acute biliary pancreatitis.

Gallbladder ascariasis.

BACKGROUND/AIMS: Gallbladder ascariasis is rarely encountered. The causative agent is Ascaris lumbricoides. Presence of ascaris inside the gallbladder can incite acalculous cholecystitis. We aimed in this report to study gallbladder ascariasis. METHODS: This is a case study of 28 patients with a diagnosis of gallbladder ascariasis from 2005 to 2010 who were seen in the Department of General Surgery, SMHS Hospital. RESULTS: Three patients with gallbladder ascariasis had associated worms in the common bile duct. On abdominal sonography, all patients showed worms as linear echogenic shadows or the worms showed 'belly dance' of worms when actively moving. Acute acalculous cholecystitis was present in 21 patients, and 7 had biliary colic. Dead worms in the gallbladder were seen in 4 patients, of which, one was fragmented and another had calcified form of parasite. Twenty-two patients had spontaneous exit of worms from the gallbladder with a time interval ranging from 1 hour to 144 hours from the time of a diagnosis. Six patients had cholecystectomy. Two patients were subjected to emergency cholecystectomy due to multiple impacted worms not exiting from the gallbladder after conservative treatment. CONCLUSIONS: Based on our experience, ultrasound diagnosis is advocated as a highly sensitive and noninvasive technique for suspected gallbladder ascariasis and it can be repeated frequently to monitor movement of worms in the gallbladder and common bile ducts.

[A rare cause of obstructive jaundice: fascioliasis]. / Nadir bir tikanma sariligi sebebi: fascioliasis.

A 56 year old woman was admitted to the clinic with severe colicky right upper abdominal pain. There was a three-week history of jaundice. Pathological biochemical laboratory results of her serum were as follows: direct bilirubin 4.53 mg/dl, total bilirubin 3.08 mg/dl, AST 45 U/L, ALT 72 U/L. Surgical treatment, cholecystectomy + choledochtomy + T-tube drainage, was performed. Exploration of the choledochus revealed two Fasciola hepatica. The patient was also given antihelmintic treatment. We present a case of fascioliasis-induced acute cholangitis that was diagnosed and treated via surgery. A review of the literature on extraction of living parasites is also included.

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.

A case report of ascariasis of the common bile duct in a patient who had undergone cholecystectomy.

This is a case report of ascariasis of the common bile duct in a 65-year-old man from Colombia who had undergone prior cholecystectomy. The patient presented with postprandial epigastric pain and a 20-lb weight loss. The laboratory findings were remarkable for peripheral blood eosinophilia. The ultrasound finding was suggestive of periampullary or pancreatic neoplasm. He underwent endoscopic retrograde cholangiopancreatography with endoscopic extraction of a motile, live worm identified as Ascaris lumbricoides. Roundworm infestation should always be suspected in immigrants from endemic areas who present with hepatobiliary symptoms.

Cryptosporidium parvum biliary tract infection in adult immunocompetent and immunosuppressed mice.

Biliary tract infection by Cryptosporidium parvum is a frequent complication of intestinal cryptosporidiosis in immunosuppressed patients. Although biliary tract infection can be produced in immunosuppressed models as a late complication of intestinal infection, there is no infection model in immunocompetent animals. A murine model of biliary tract cryptosporidiosis was developed by direct intra-gall bladder injection of C. parvum oocysts. In adult immunocompetent mice, intracellular parasitic stages were detected in the epithelium of the common bile duct in all animals on day 7 post-inoculation (p.i.). These findings were associated with a strong inflammatory reaction. Infection was cleared between days 14 and 21 p.i. All animals developed significant levels of specific serum and bile IgG, IgA and IgM. Dexamethasone treatment resulted in the inability of animals to eradicate the parasite and the establishment of ileal parasitism. This model can be used to study the immunological mechanisms involved in the control of biliary cryptosporidiosis.

[37 patients with hepatic hydatid cyst rupturing into choledochus].

2785 patients with hepatic hydatid cyst were treated operatively since 1965 to 1995, and the hydatid cyst rupturing into choledachus occurred in 37 patients (1.3%). Clinical manifestations, diagnosis and operation were described. In epidemic area the possibility of hepatic hydatic cyst rupturing into choledochus should be considered when the patient suffers from stiffness of abdominal muscles, Jaundice, right epigastric pain, hepatic mass and positive reaction of Casoni test. Ultrasound and CT are major means for the diagnosis of this disease. Early operation is the treatment of choice.

[Endoscopic retrograde cholangiopancreatography and sphincterotomy in parasitic diseases]. / Pancreatocolangiografía retrógrada endoscópica y esfinterotomía en las parasitosis.

We report six patients with billary duct obstruction due to parasites (Fasciola hepatica, ascariasis and hydatid cyst) that were diagnosed and managed with the endoscopic approach. This is the first national paper which highlights the importance of endoscopic retrograde cholangiopancreatography in the management of this parasitosis. Despite choledocholithiasis as the most common cause of extrahepatic jaundice, biliary tree parasitosis must be considered in the differential diagnosis.

Ascariasis en vesícula y vías biliares / Ascariasis in gall-bladder and bile ducts

La ascariasis del árbol biliar es una entidad quirúrgica poco común por lo que es susceptible de originar problemas de diagnóstico diferencial. En este trabajo se presenta un caso de colecistitis por áscaris impactado con el conducto cístico y dos casos de áscaris localizados en el colédoco. Se hace un análisis retrospectivo de las características del cuadro clínico que pueden orientar al diagnóstico etiológico. Se concluye que esta entidad debe sospecharse en pacientes de nivel socioeconómico bajo, provenientes del medio rural o de áreas tropicales que presentan síntomas de cólico biliar atípico

Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case.

This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.

Acalculous clonorchiasis obstructing the common 3ile duct: a case report and review of the literature.

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.

Current status and usefulness of operative cholangiography.

This article is a review of the recent literature on operative cholangiography. The objective is to summarize concisely the important contemporary viewpoints as an aid to students of radiology. To the practicing radiologist, it may offer a concise review of the subject and facilitate upgrading operative cholangiography in his hospital. The introduction covers statistical evidence of the growing dependence of biliary tract surgeons on operative cholangiography. The rudiments of diagnoses of the various diseases that can be detected by operative cholangiography are presented. Pertinent clinical facts along with cholangiographic diagrams are presented under arbitrary sections: I. Stones; II. Anomalies; III. Other Diseases; IV. Techniques of Operative Visualization of the Biliary System.