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.

Surgical approach to symptomatic giant cavernous hemangioma of the liver.

BACKGROUND/AIMS: Surgical treatment of giant cavernous hemangioma of the liver is still controversial. In this study, indications and results of surgical therapy were evaluated. METHODOLOGY: Fifteen patients with symptomatic giant cavernous hemangioma of the liver were treated by enucleation or liver resection. RESULTS: The surgical indications were abdominal pain in 11 patients, uncertain diagnosis in 3 patients and tumor enlargement in one patient. The median tumor size was 12.5cm (range, 6-30cm). Eleven patients underwent enucleation procedure while the other 4 patients underwent resection procedures. Complications occurred in 2 (13.4%) patients. The patient with the largest tumor underwent right extended lobectomy and died of bleeding and coagulopathy (6.7%). The postoperative hospital stay was 7 days (range, 4-16 days). Thirteen patients were followed-up for an average period of 32.8 months (range, 6-88 months). It was found that the symptoms for 12 of 13 patients disappeared. During the postoperative controls carried out by imaging procedures, no recurrences were observed. CONCLUSIONS: Abdominal pain, uncertain diagnosis and enlargement are major surgical indications of symptomatic giant cavernous hemangiomas. Most of the symptoms disappear after the surgical treatment. Enucleation can be successively performed with low morbidity rates in most of the patients and recurrences are rare. If the tumor location precludes safe enucleation, anatomic resections are preferred.