title: [Fasciola hepatica--a unusual cause of acute cholecystitis with cholestatic jaundice].
abstract: A 29-year-old patient was admitted with acute abdomen in the 17th week of pregnancy. History revealed two episodes of colic in the right hypochondriac area during the previous six months, but no other abdominal complaints. Clinically the picture was that of acute cholecystitis. Laboratory findings included an elevated white cell count, a slight elevation of serum transaminases and a marked increase of serum alkaline phosphatase and bilirubin. Echographically there were dilated intra- and extrahepatic bile ducts containing two hyperechogenic elements without casting an acoustic shadow. A hydrops of the gallbladder with sludge and a thickening of the wall could also been seen. Because of pregnancy an ERCP could not be performed due to the need for X-ray, so we had to resort to open surgery. Under tocolytic and antibiotic shielding we carried out open cholecystectomy and choledochoscopic exploration of the common bile duct. Using a Fogarty balloon catheter we extracted two live, adult liver flukes and placed a T-tube in the duct. Because of positive fecal probes for fasciola eggs the T-tube had to be left in place until childbirth. Afterwards we performed a pre-cut-papillotomy by ERCP and took the T-tube out, having confirmed a clear duct on a T-tube-cholangiogram. With negative fecal probes and the eosinophilia on the white cell count returning to normal, we decided against the planned chemotherapy and assumed self-healing of the disease. The patient has been well since.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D000006:Abdomen, Acute / Q000469:parasitology; D000328:Adult; D000818:Animals; D002758:Cholangiography; D002764:Cholecystitis / Q000000981:diagnostic imaging / Q000469:parasitology* / Q000601:surgery; D005210:Fasciola hepatica / Q000254:growth & development; D005211:Fascioliasis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D010270:Parasite Egg Count; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000469:parasitology*; D014463:Ultrasonography
vernacular_title: Fasciola hepatica--eine seltene Ursache der akuten Cholezystitis mit cholestatischem Ikterus.