Dr. Subhash Agal
A 36 yrs old women presented to Kokilaben Hospital on 23rd March 2009 with history of Recurrent Cholangitis for last six months.
She was seen by Dr.Subash Agal, Consultant Gastroenterologist at KDAH.
She gave history of episodic epigastric pain and fever lasting for 2 - 3 days each time.
An ultrsasound done 6 months earlier was reported as liver abscess and she was treated with antibiotics without any relief.
An MRI with MRC was performed on her. MRI showed heterogenous lesions in right as well as left lobe of liver each measuring approximately 3 - 5 cm in size. The lesions showed cystic ( with septae) and solid components. Magnetic Resonance Cholangiography showed dilatation of left hepatic duct, normal caliber common bile duct and irregular filling defect in distal CBD.
Her liver profile was normal except mild increase in enzyme gamma glectamyl transferase. Her CBC and EXR were within normal limits.
An ERCP was performed on her by Dr. Subash Agal on 25/03/09. Cholangiogram showed irregular filling defect in mid and distal CBD. After biliary sphincterotomy, basketing of CBD revealed a live leaf like reddish brown worm was identified as liver fluke or fasciola hepatica. The patient showed remarkable improvement after the procedure.
Fasciola hepatica also known as sheep liver fluke, is an uncommon worm infestation. Eggs from infected animal's feces hatch into miracidia. The latter enter the snails and develop into cercaviae which attach to the aquatic plants. Man becomes infected by consuming plants containing encysted metacercariae. They bore through intestinal wall to enter into peritoneal cavity and then penetrate the liver capsule and finally come to lie into the bile ducts where they eventually develop into adult forms.
Symptoms due to this worm could be initially due to migration of worms through the intestine, peritoneal cavity and liver.
The patient presents with fever, pain in right hypochondrium and urticaria.
Recurrent biliary colic and cholangitis are late features when worm lies in biliary ductis.
Liver pathology includes necrosis,granuloma with eosinophilic infiltrates & Charcot - Leyden crystals.
The medical treatment consists of administration of triclabendajole.