Clonorchiasis sinensis detected by laparoscopic exploration of biliary tracts in two patients with obstructive jaundice

Abstract

Background: Hepatic clonorchiasis is one of the most prevalent food-borne parasitic diseases worldwide. Clonorchis sinensis, the pathogen, is the major parasitic trigger contributing to cholangitis, cholelithiasis, and even cholangiocarcinoma. Unfortunately, unspecific clinical manifestations of patients with hepatic clonorchiasis tend to mislead clinicians to neglect or misdiagnose them, following ignorance of appropriate therapy. Our case report may shed light on definite diagnosis of clonorchiasis with concomitant cholelithiasis, methodology for surgical drainage of the parasites, and postoperative anthelmintic therapy.

Case presentation: Two patients with habit of eating infected raw or undercooked freshwater fish were hospitalized due to right upper quadrant pain and jaundice. Magnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) detection indicated cholangiolithiasis and cholangiolithiasis with concurrent cholecystolithiasis, respectively. Fecal examinations were both negative for adult worms or eggs of parasites. However, adults of Clonrochis sinensis were detected within hepatobiliary tracts during laparoscopic cholecystectomy. Postoperative drainage and anthelmintic therapy contributed to complete recovery with good prognosis.

Conclusions: Clonorchiasis provokes cholangiolithiasis and cholecystolithiasis. Standardized treatments for these gallstone patients with concomitant clonorchiasis include surgical removal of the calculus, postoperative T tubule drainage and anthelmintic therapy. Serological test or polymerase chain reaction (PCR)-based approaches might be helpful for diagnosis of clonorchiasis when no eggs are found by stool microscopy. Public health promotion on ceasing to eat raw freshwater fish is essential for prevention and control of clonorchiasis.

Keywords: Clonorchiasis; Gallstone; Obstructive jaundice.

Fig. 1

Dilation of the intrahepatic ducts by MRCP

Fig. 2

Examination of the stone and the worms in common bile duct by the choledochoscope during operation

Fig. 3

Dilation of the intrahepatic ducts by CT scan

Fig. 4

Laparoscopic view of the operation

Fig. 5

Choledochoscope view of worms inside the bile duct

Fig. 6

Nodules (indicated by arrows) distributed on the surface of the liver

Fig. 7

C. sinensis worms drained through the catheter