Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis

Abstract

Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis.

Keywords: Acute cholangitis; Fascioliasis; Intraductal ultrasonography.

Fig. 1.

(A) Magnetic resonance cholangiopancreatography showing dilated extrahepatic bile duct without any definite cause of obstruction. (B) Endoscopic retrograde cholangiogram does not reveal any cause of acute cholangitis.

Fig. 2.

(A) Initial findings of the intraductal ultrasonography revealing crescent-layered wall thickening in the right main hepatic duct. (B) Intraductal ultrasonography showing an actively motile tubular structure in the bile duct. (C) Endoscopic appearance of Fasciola hepatica showing a leaf-like trematode extracted by using a balloon catheter. (D) Finding of F. hepatica after fixation in formalin.