Case Report

A 53-Year-Old Man with Intermittent Colicky Abdominal Pain due to Fasciola Incarceration in Common Bile Duct: A Case

Abstract

Fascioliasis is a zoonotic disease caused by liver flukes of the genus Fasciola, as F. hepatica, and F. gigantica, mainly affecting the liver and biliary system during the chronic phase. These trematodes migrate through biliary ducts results in mild inflammation, when it is difficult to distinguish from obstructive lesions. Here we describe a 53-yr-old man from Golpayegan, a city in Isfahan Province, Iran, in year 2015, with occasional fever and chills, and also frequent colicky abdominal pain mainly on the right upper quadrant, with tenderness at that part. There was no jaundice and elevated bilirubin, but increased alkaline phosphatase was detected. Dilated common bile duct on abdominal sonography, without any visible lesion at its end and also dilated intra- and extrahepatic biliary ducts on abdominal CT-scan were seen. Endoscopic Retrograde Cholangiopancreatography (ERCP) detected incarceration of parasites behind Oddi's sphincter and also in common bile duct and serologic test (ELISA) confirmed fascioliasis. However, Iran is one of the most affected countries by Fasciola, being aware of rare symptoms and presentations of this disease can aid the physicians to make timely and accurate diagnosis and therefore reduce the consequent morbidities.

- Ashrafi K. The Status of Human and Animal Fascioliasis in Iran: A Narrative Review Article. Iran J Parasitol. 2015 Jul-Sep; 10(3):306–328.

- Moghadami M, Mardani M. Fasciola hepatica: A cause of obstructive Jaundice in an elderly man from Iran. Saudi J Gastroenterol 2008; 14:208-210.

- Niknam R, Kazemi MH, Mahmoudi L. Three Living Fasciola Hepatica in the Biliary Tract of a Woman. Iran J Med Sci. 2015 Sep; 40(5):465-68.

- Ha JS, Choi HJ, Moon JH, Lee YN, Tae JW, Choi MH, et al. Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis. Clin Endosc. 2015 Nov; 48(6):579–582.

- Keshishian J, Brantley SG, Brady PG. Biliary fascioliasis mimicking sphincter of Oddi dysfunction. South Med J. 2010 Apr; 103(4):366–68.

- Al Qurashi H, Masoodi I, Al Sofiyani M, Al Musharaf H, Shaqhan M, All GNAA. Biliary fascioliasis – an uncommon cause of recurrent biliary colics: Report of a case and brief review. GMS German Medical Science 2012; 10:Doc10. doi: 10.3205/000161.

- Losada H, Hirsch M, Guzmán P, Fonseca F, Hofmann E, Alanís M. Fascioliasis simulating an intrahepatic cholangiocarcinoma—Case report with imaging and pathology correlation Hepatobiliary surgery and nutrition 2015 Feb; 4(1) E1-7.

- Alshekhani M, Hussein H, Karbuli T, Kasnazan K. Large number of Fasciola hepatica discovered during endoscopic retrograde cholangiopancreatography (ERCP). Case Reports in Clinical Medicine 2013; 2(2):177-78.

- Fürst T, Keiser J, Utzinger J. Global burden of human food-borne trematodiasis: a systematic review and meta-analysis. Lancet Infect Dis. 2012; 12(3):210-21.

- Torgerson PR, Macpherson CNL. The socioeconomic burden of parasitic zoonoses: Global trends. Veterinary Parasitology 2011 Nov; 182(1):79–95.

- Nyindo M, Lukambagire AH. Fascioliasis: An Ongoing Zoonotic Trematode Infection. BioMed research international 2015; 2314-6141.

- Hotez PJ, Brindley PJ, Bethony JM, King CH, Pearce EJ, and Jacobson J. Helminth infections: the great neglected tropical diseases. J Clin Invest. 2008 Apr; 118(4):1311–21.

- Hotez PJ, Molyneux DH, Fenwick A, Kumaresan J, Ehrlich Sachs S, Sachs JD, et al. Control of Neglected Tropical Diseases. N Engl J Med 2007 Sep; 357:1018-27.

- Boşnak VK, Karaoğlan I, Sahin HH, Namiduru M, Pehlivan M, Okan V, et al. Evaluation of patients diagnosed with fascioliasis: A six-year experience at a university hospital in Turkey. J Infect Dev Ctries. 2016 Apr; 10(4):389-94.

- Mekky MA, Tolba M, Abdel-Malek MO, Abbas WA, Zidan M. Human fascioliasis: a re-emerging disease in upper Egypt. The American journal of tropical medicine and hygiene 2015 Jul; 93(1):76-9.

- World Health Organization (2010). Working to overcome the global impact of neglected tropical diseases: first WHO report on neglected tropical diseases.

- Salahi-Moghaddam A, and Arfaa F. Epidemiology of Human Fascioliasis Outbreaks in Iran. J Arch Mil Med. 2013 Nov; 1(1):6-12.

- Ashrafi K, Saadat F, O’Neil S, Rahmati B, Amin Tahmasbi H, Pius Dalton J, et al. The Endemicity of Human Fascioliasis in Guilan Province, Northern Iran: the Baseline for Implementation of Control Strategies. Iran J Public Health. 2015 Apr; 44(4):501–511.

- Manouchehri Naeini K, Mohammad Nasiri F, Rokni MB, Kheiri S. Seroprevalence of Human Fascioliasis in Chaharmahal and Bakhtiyari Province, Southwestern Iran. Iranian Journal of Public Health 2016; 45(6):774-80.

- Saberinasab M, Mohebali M, Molawi G, Beigom Kia E, Aryaeipour M, Rokni MB. Seroprevalence of human fascioliasis using indirect ELISA in isfahan district, central iran in 2013. Iranian journal of parasitology 2014 Oct; 9(4):461-5.

- Ashrafi K, Valero MA, Massoud J, Sobhani A, Solaymani-Mohammadi S, Conde P, et al. Plant-borne human contamination by fascioliasis. Am J Trop Med Hyg. 2006; 75(2):295–302.

- Halimi M, Farajzadeh M, Delavari M, Arbabi M. Developing a climate-based risk map of fascioliasis outbreaks in Iran. J Infect Public Health 2015 Sep-Oct; 8(5):481-6.

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IssueVol 13 No 4 (2018) QRcode
SectionCase Report(s)
Keywords
Fascioliasis Cholangiocarcinoma Endoscopic retrograde cholangiopancreatog-raphy

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How to Cite
1.
YADEGARINIA D, TEHRANI S, DOOSTI Z. A 53-Year-Old Man with Intermittent Colicky Abdominal Pain due to Fasciola Incarceration in Common Bile Duct: A Case. Iran J Parasitol. 2018;13(4):664-668.