Maimonides Medical Center Brooklyn, NY, United States
Diana Cheung, MD, Jeffrey Halperin, MD, Matthew D. Grunwald, MD, Meredith E. Pittman, MD, Dmitriy O. Khodorskiy, MD Maimonides Medical Center, Brooklyn, NY
Introduction: Liver flukes can cause parasitic inflammatory disease of the bile ducts. The clinical manifestation depends on the degree of infection and the presence of complications. The vast majority of patients are asymptomatic, although symptoms are typically nonspecific complaints such as abdominal discomfort, nausea, and vomiting. We present a case of intrahepatic biliary obstruction secondary to trematodiases in a patient who complained of vague abdominal discomfort.
Case Description/Methods: A 66-year-old Chinese man with a past medical history of hypertension initially presented to his outpatient primary care physician with a chief complaint of abdominal pain for three months associated with bloating. His blood work was consistent with obstructive jaundice. Magnetic resonance cholangiopancreatography (MRCP) revealed a dilated common bile duct (CBD) to 0.9 cm with multiple small filling defects, initially thought to represent calculi. He underwent endoscopic ultrasonography (EUS), which also revealed a small filling defect in the CBD (Figure 1). He subsequently underwent endoscopic retrograde cholangiopancreatography (ERCP). The cholangiogram revealed an irregularly shaped filling defect in the proximal CBD (Figure 2). Multiple balloon sweeps of CBD were performed resulting in extraction of a worm-like organism (Figure 3). Pathology revealed the organism to be a hepatic trematode (Figure 4). Upon further questioning, the patient revealed that he had worked as a rice paddy farmer in rural China until 2016. He often ate cooked snails and did not keep a diet of undercooked or raw freshwater fish. The patient felt well post-procedure and is currently planned for treatment with praziquantel.
Discussion: Despite the fact that most patients infected with liver fluke are typically asymptomatic, long standing infection can result in chronic inflammation of the bile ducts, leading to development of suppurative cholangitis and eventually, cholangiocarcinoma, decades after initial infection. Obstructive jaundice in patients with associated risk factors such as living in endemic areas (Southeast Asia), occupation (rice farmer, fishermen), and other high-risk behaviors (raw freshwater fish consumption) should prompt evaluation for parasitic infections. Liver fluke infection is an important medical condition with potentially life-threatening consequences that is commonly mis-/under-diagnosed, therefore clinicians should maintain a high index of suspicion for this disorder in at-risk patients.
Disclosures: Diana Cheung indicated no relevant financial relationships. Jeffrey Halperin indicated no relevant financial relationships. Matthew Grunwald indicated no relevant financial relationships. Meredith Pittman indicated no relevant financial relationships. Dmitriy Khodorskiy indicated no relevant financial relationships.
Diana Cheung, MD, Jeffrey Halperin, MD, Matthew D. Grunwald, MD, Meredith E. Pittman, MD, Dmitriy O. Khodorskiy, MD. P0081 - A Case of Trematodiases in Rice Farmer With Abdominal Pain, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.