Unusual findings during endoscopic retrograde pancreatocholangiography [ERCP]: 2 cases of fasciola hepatica in common bile duct removed intact during the procedure

ABSTRACT

Humans are accidental host for Fasciola hepati+ca after ingestion of raw green vegetables contaminated with encysted metacercariae, they finally settle in the biliary tree causing cholestasis. Our 2 cases presented with fever, right upper quadrant abdominal pain and jaundice. Investigations revealed elevated total serum bilirubin and liver enzymes with dilatation of the common bile duct on ultrasonography in both cases. After considering the differential diagnosis, Endoscopic retrograde cholangiopancreatography [ERCP] was considered, During [ERCP], in both cases, a filling defect was identified in the common bile duct, after sphincterotomy and balloon extraction, live Fasiola hepaticas were extracted and physically removed. Fasciola hepatica should be included in the differential diagnosis of common bile duct obstruction and when ERCP is available it can be diagnosed and treated relatively easily