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Intrahepatic Duct Stones Harboring Ascariasis Ova

View Article: PubMed Central - PubMed

ABSTRACT

Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication—hepatolithiasis.

A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.

Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.

No MeSH data available.


Related in: MedlinePlus

Pigment stones (black arrow) in left IHD were shown intraoperatively. IHD = intrahepatic duct.
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Figure 2: Pigment stones (black arrow) in left IHD were shown intraoperatively. IHD = intrahepatic duct.

Mentions: As a result, the patient was taken up for surgery. Grossly, the left liver parenchyma was markedly atrophied with fibrotic change. Left hemi-hepatectomy with cholecystectomy was performed; pigment stones were removed after opening the left IHD, which contained white bile due to obstruction (Figure 2). The common bile duct (CBD) was explored and main biliary trees were examined by a choledochoscope. Biliary stricture and pigment stones were found in the left hepatic duct. Final pathology reports showed that the liver parenchyma had inflammatory and fibrotic change (Figure 3A), whereas it consisted of dilated bile ducts with pigment stones harboring Ascaris ova (Figure 3A and B). The histological examination revealed active fibrosis and an inflammatory infiltrate consisting of lymphocytes, eosinophils, and plasma cells around the dilated bile ducts in which pigmented stones resided. Marked proliferation of small bile ductules with atrophy of hepatic parenchyma was noted. The hepatic parenchyma showed pronounced fibrous expansion of portal tracts and frequent bridging fibrosis (Figure 3A and B). The postoperative period was uneventful. The patient received antihelminthic therapy orally and was on regular follow-up for 4 years without any complications.


Intrahepatic Duct Stones Harboring Ascariasis Ova
Pigment stones (black arrow) in left IHD were shown intraoperatively. IHD = intrahepatic duct.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998388&req=5

Figure 2: Pigment stones (black arrow) in left IHD were shown intraoperatively. IHD = intrahepatic duct.
Mentions: As a result, the patient was taken up for surgery. Grossly, the left liver parenchyma was markedly atrophied with fibrotic change. Left hemi-hepatectomy with cholecystectomy was performed; pigment stones were removed after opening the left IHD, which contained white bile due to obstruction (Figure 2). The common bile duct (CBD) was explored and main biliary trees were examined by a choledochoscope. Biliary stricture and pigment stones were found in the left hepatic duct. Final pathology reports showed that the liver parenchyma had inflammatory and fibrotic change (Figure 3A), whereas it consisted of dilated bile ducts with pigment stones harboring Ascaris ova (Figure 3A and B). The histological examination revealed active fibrosis and an inflammatory infiltrate consisting of lymphocytes, eosinophils, and plasma cells around the dilated bile ducts in which pigmented stones resided. Marked proliferation of small bile ductules with atrophy of hepatic parenchyma was noted. The hepatic parenchyma showed pronounced fibrous expansion of portal tracts and frequent bridging fibrosis (Figure 3A and B). The postoperative period was uneventful. The patient received antihelminthic therapy orally and was on regular follow-up for 4 years without any complications.

View Article: PubMed Central - PubMed

ABSTRACT

Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication—hepatolithiasis.

A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.

Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.

No MeSH data available.


Related in: MedlinePlus