A Rare Case of Human Liver Fluke with a Sequel of Oriental Cholangitis, Obstructive Hepatopathy and Mirizzi Syndrome

Abstract

Purpose: Opisthorchis felineus, a liver fluke that consumes bile, can cause a number of hepatobilary diseases in humans who serve as an accidental host. The liver fluke is acquired through different types of snails and fish and typically resides in the biliary ducts but can also live in the pancreatic duct or gallbladder. Although biliary disease secondary to Opisthorchis felineus is an endemic in Russia and Siberia it is an uncommon phenomenon in the United States. We present a case of a 40 year old female Russian immigrant who presented with biliary colic, pruritis, chills, fever, and laboratory tests consistent with obstructive jaundice. Her ERCP revealed extrahepatic biliary obstruction, oriental cholangitis, acute cholecystitis, and Mirizzi's syndrome due to opisthorchis felineus induced biliary stricture and choledocholithiasis. Aspirated bile analysis revealed parasitic organisms identified as Opisthorchis felineus ova and adult liver flukes. This case illustrates the severity of signs and complications that occurs with biliary Opisthorchis felineus infections. We also discuss diagnostic methods used for confirmation including ERCP with aspirated bile cytology and treatment including anti-helminth therapy, ERCP with biliary stent decompresion, endoscopic choledocholithectomy and cholecystectomy.Figure. 9: mm stone extracted from CBD.Figure: Opisthorchis felineus ova from biliary aspirate.