A Rare Cause of Recurrent Pain Abdomen Managed by ERCP

Abstract

Purpose: Recurrent pain abdomen is common presentation in gastroenterology practice. Here, we report a rare case of recurrent pain right upper quadrant. Methods: Case report Results: A 28 years female presented with pain right upper abdomen of 2 months duration. There was no history of fever or jaundice. There was no history of bowel disturbance or urinary symptom. Ultrasonography showed multiple cystic lesions in both lobe of liver. Hemogram showed Hb- 9.4gm/dl, WBC count - 9100/dl with eosinophil- 36%. Liver function test showed AST - 64 IU/L, ALT - 84 IU/L and ALP - 746 IU/L. She was started on oral metrondiazole, ofloxacin and antispasmodics. Intermittent pain continued and she started to have low grade fever. CT abdomen revealed multiple complex cysts on both lobe of liver (Fig 1). Aspiration revealed brownish material. Bile pigment was noted on aspirated material and culture was sterile. ERCP was done, which showed irregular filling defects in bile duct with communication with on of the cyst. On balloon extraction, 3 live fasciola hepatica were removed (Fig 2). She received Triclabendazole and doing well on follow up.Figure: CT abdomen showing complex cysts.Figure: Fasciola hepatica removed from bile duct at ERCP.Conclusion: The liver fluke, Fasciola hepatica presenting as recurrent pain abdomen is rare. Also, Fasciola hepatica infestation is not reported from this part of world. Finally, patient was managed by removal of live Fasciola at ERCP.