Cholangiocarcinoma in Magnetic Resonance Cholangiopancreatography and Fascioliasis in Endoscopic Ultrasonography

Abstract

Fascioliasis is a worldwide zoonotic infection with Fasciola hepatica and Fasciola gigantica. The zoonoses are particularly endemic in sheep-raising countries and are also endemic in Iran. Typical symptoms that may be associated with fascioliasis can be divided by phases of the disease, including the acute or liver phase, the chronic or biliary phase, and ectopic or pharyngeal fascioliasis. Cholestatic symptoms may be absent, and in some cases diagnosis and treatment may be preceded by a long period of abdominal pain, eosinophilia and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 4 years, with imaging suggesting cholangiocarcinoma. Considering a new concept of endoscopic ultrasonography, at last F. hepatica was extracted with endoscopic retrograde cholangiography.

Finding of Biliary Fascioliasis by Endoscopic Ultrasonography in a Patient with Eosinophilic Liver Abscess

“…Our case did not have significant peripheral eosinophilia or typical clinical presentation, while eosinophilia is very common in the acute phase, and there were no biliary obstruction symptoms. Besides, in comparison to other cases in the literature, the initial imagings did not show any abnormality in the biliary ducts, despite the patient having eosinophilic liver abscess [14, 15, 16, 17, 19, 20, 21]. Stool examination may be negative for fascioliasis, and there is no obvious suggestive diagnostic clue, so this highlights the fact that F. hepatica should be considered in the differential diagnosis of ambiguous hepatobiliary symptoms, especially in endemic areas.…”

“…The biliary phase is usually asymptomatic, but may present with intermittent right upper quadrant pain with or without cholangitis or cholestasis [ 11 ]. Occasionally, the adult flukes can obstruct the CBD and thus induce chronic infection leading to biliary colic, cholangitis, cholelithiasis, obstructive jaundice and even secondary pancreatitis [ 11 , 14 , 15 , 16 , 17 ]. Morbidity can increase with heavier fluke burdens [ 12 ].…”

Large number of <i>Fasciola hepatica</i> discovered during endoscopic retrograde cholangiopancreatography (ERCP)

“…These case appeared after the mini epidemic that occurred in Krminshah, Iran & increasingly case reports from Van area, Turkey [6][7][8], both of which areas are close to Iraqi Kurdistan & we think that the herbivores trafficking across the boarders had participated in transporting the infection to our area. The case under discussion & most of our cases are discovered during ERCP or surgery unexpectedly, because the infection was not prevalent before & the clinicians, surgeons & radiologists are still they not be familiar with the disease, in addition to the fact that its clinical & imaging features may simulate other hepatobilairy diseases [3,9].…”

“…Making things more difficult that biliary faciolosis can mimic & can cause common causes of biliary obstruction namely cholelithiais & cholangiocarcinoma. Experienced abdominal & endoscopic sonographists can diagnose the infection if they observe moving objects in the gall bladder or common bile duct during their search for hepatobilairy pathologies & frequebtly they are gaining experience in that respect [2,3].…”

Biliary fascioliasis – an uncommon cause of recurrent biliary colics: Report of a case and brief review

“…The radiological picture of fascioliasis may even mimic other biliary disorders. For example Mohammad et al [ 9 ] reported a 34-year-old male with obstructive jaundice having features of cholangiocarcinoma on magnetic resonance cholangiopancreatography (MRCP). Their patient proved to have fascioliasis on ERCP.…”