[A rare case of obstructive jaundice and cholecystitis in hepatic fascioliasis in Italy].
The human infestation caused by Fasciola hepatica is a rare zoonosis, with an incidence of about 10 cases/year in Italy. We report a case of cholecystitis and obstructive jaundice in a patient affected by fascioliasis in which the diagnosis was secondary to the extraction of viable flukes from the bile duct during ERCP. The endoscopic examination permits, in addition to a rapid, correct diagnosis, direct clearance of the bile ducts. Oral drug therapy, when carried out following the endoscopic treatment, is aimed at killing any flukes potentially evading mechanical clearance. The healing achieved is confirmed by normalisation of antibody levels 6-12 months after therapy. Cholecystectomy is indicated and appropriate for the frequent occurrence of biliary colic related to acute and chronic cholecystitis and cholelithiasis, induced by the presence of the flukes. Infestation by Fasciola hepatica has to be considered among the differential diagnoses of obstructive jaundice. ERCP plays a major diagnostic and therapeutic role, and cholecystectomy, considering the pathogenetic effects of flukes on the organ, is mandatory.
Caprino
Paola
P
UOC di Chirurgia Generale, Ospedale San Paolo, ASL RM F, Civitavecchia, Roma.
Ferranti
Fabrizio
F
Passa
Giuseppe
G
Quintiliani
Alberto
A
D000368:Aged; D000818:Animals; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D002764:Cholecystitis / Q000209:etiology* / Q000601:surgery; D041881:Cholecystitis, Acute / Q000209:etiology / Q000601:surgery; D002769:Cholelithiasis / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D005211:Fascioliasis / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D007558:Italy; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D015047:Zoonoses