Case Study 5 - Acute Cholangitis

September 8, 20082comments

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results of liver-function tests were abnormal, showing elevated levels of aspartate aminotransferase (350 IU per liter), alanine aminotransferase (352 IU per liter), alkaline phosphatase (204 IU per liter), gama-glutamyltransferase (434 IU per liter), total bilirubin (6.4 mg per deciliter [109 ┬Ámol per liter]), and conjugated bilirubin (3.9 mg per deciliter [67 ┬Ámol per liter]). The white-cell count was also elevated (13,000 per cubic millimeter), and there was eosinophilia (27%). A computed tomographic scan of the abdomen showed dilatation of the common bile duct without definite filling defects. Given our concern that the patient might have acute cholangitis, a duodenoscopy was performed, and a prominent major papilla was discovered. After cannulation of the common bile duct, numerous leaf-shaped worms popped out (click here or on image to see video).

Based on the above information, identify the worms and enter your answer in comments section.


Do Hyun Park,
Hyun-Young Son
University of Ulsan College of Medicine
South Korea
Courtesy: New England Journal of Medicine
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+ comments + 2 comments

September 8, 2008 at 9:19 PM

its a liver fluke. May be Clonorchis sinensis or Fasciola hepatica.

September 18, 2008 at 5:19 PM

Hats off to Mullai, for the optimal diagnosis of this rare case.

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