title: Biliary Fasciola gigantica infestation in a nonendemic area--An intraoperative surprise.
abstract: A 7year old girl infected with the zoonotic trematode, Fasciola gigantica is reported because of the extreme rarity of this condition in our region. Because of the overlap in symptomatology and radiological features, the more common amebic/pyogenic liver abscess in the initial hepatic migratory phase and later choledochal cyst/biliary ascariasis when the parasite was finally located in the extrahepatic bile ducts, were thought of delaying effective treatment. The diagnosis was confirmed only by surgical exploration. The characteristic contrast enhanced computed tomography scan features retrospectively identified were multiple clustered hypodense lesions in the liver with peripheral enhancement in the acute hepatic migratory phase, and periportal tracking in the previously affected areas of the liver with biliary dilatation and a linear hypointense lesion within the common bile duct in the chronic phase. Although a known association, she did not have eosinophilia. This child, who became symptomatic at the age of 5.5years, also appears to be one of the youngest patients reported with Fasciola gigantica.
authors.affiliation: Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: menonprema@hotmail.com.
authors.forename: Prema
authors.initials: P
authors.lastname: Menon
authors.affiliation: Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Sinha
authors.affiliation: Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Katragadda Lakshmi Narasimha
authors.initials: KL
authors.lastname: Rao
authors.affiliation: Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sumeeta
authors.initials: S
authors.lastname: Khurana
authors.affiliation: Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sadhana
authors.initials: S
authors.lastname: Lal
authors.affiliation: Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Babu Ram
authors.initials: BR
authors.lastname: Thapa
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000818:Animals; D001662:Biliary Tract Surgical Procedures; D002648:Child; D015529:Choledochal Cyst / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D005209:Fasciola / Q000302:isolation & purification*; D005211:Fascioliasis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans
keywords: Biliary dilatation; Computed tomography; Fasciola gigantica; Liver abscess; Liver fluke; Neglected tropical disease