Use of Laparoscopic Ultrasonography in Surgical Procedures of Hepatobiliary and Pancreatic Diseases

Abstract

Brief Description of the Purpose of the Report: The aim of our report is to describe the typical ultrasonographic features of gallbladder infestation by Clonorchis sinensis. Medical History: A 34 year-old-man, recently returned from China, was hospitalized for fever, jaundice and epigastralgia. He reported an ingestion of Yusheng, a Chinese raw fish salad. Objectively, he had fever and positive Murphy’s sign. Laboratory workout documented an increase of inflammatory and cholestasis markers. Ultrasound showed a distended gallbladder with thickened walls and lumen occupied by stratified material compatible with biliary sludge. In the dependent portion of the gallbladder, a flocculent, nonshadowing and floating group of echos was appreciated. It changed in position in reaction to a light blow with the transducer. Diagnosis: The sonographic aspects were consistent with previous reports of gallbladder infections by Clonorchis sinensis [1]. The report was confirmed by a stool examination, positive for Clonorchis sinensis. After treatment with mebendazole, the patient became asymptomatic. Discussion and Summary of the Case: The gallbladder involvement by parasites is unusual, but should be considered in the differential diagnosis in the presence of a suggestive history and typical sonographic features. Early medical treatment is associated with a rapid clinical improvement, thus avoiding any surgical approach.