Case Report Acute Cholecystitis Caused by Clonorchis Sinensis

We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery. ACUTE CHOLECYSTITIS CAUSED BY C. SINENSIS Vol 37 No. 4 July 2006 649 Fig 1–Grass carp, Ctenopharyngodon idellus, freshwater fish, a second intermediate host for Clonorchis sinensis that harbors the encysted metacercariae. dominal discomfort, abdominal pain, dizziness hepatomegaly and splenomegaly. In severe infections the most common complication is recurrent pyogenic cholangitis, also known as Oriental cholangio hepatitis. These patients have repeated attacks of fever, chills, abdominal pain, jaundice and hepatomegaly. They may die of hepatic failure if there is no surgical intervent ion (Daniel et al, 1997). In long-standing infections, cholangitis, cholelithiasis, pancreatit is and cholangiocarcinoma can develop. Part icular ly heavy infections can also result in narrowing or blockage of the bi le ducts. Diagnosis of clonorchiasis is based on the recovery of the characteristic eggs in the feces or in duodenal aspirate (Beaver et al, 1984). The eggs require differentiatomy and exploration of the common bile duct should be performed. Prognosis is good in light infections, but is less satisfactory in heavy or chronic infections (Beaver et al, 1984). Thorough cooking of all freshwater fish will assure protection of the human population (Beaver et al, 1984). Control of infection has been achieved in some areas by a combination of chemotherapy, health education and improved sanitation. Metacercariae are not killed by refrigeration, salting, or the addition of vinegar or sauce (Neva and Brown, 1994). Fig 2–Adult worms of Clonorchis sinensis collected from the bile duct and gallbladder of the patient. tion from Opisthorchis, another species of liver fluke. The eggs of Opisthorchis closely resembles those of Clonorchis sinensis. Radiologic techniques provide indirect evidence of parasi t ic infect ion in the bi le ducts. Noninvasive ultra sonography has gradually replaced cholangiography. Computered tomography has also been used in the diagnosis of clonorchiasis (Daniel et al, 1997). Praziquantel is the drug of choice. In the case of heavy infections complicated by obstructive jaundice requiring surgical intervention, cholecystecSOUTHEAST ASIAN J TROP MED PUBLIC HEALTH 650 Vol 37 No. 4 July 2006 Fig 3–Clonorchis sinensis, adult specimen stained with carmine. Fig 4–Eggs of Clonorchis sinensis, from the ruptured uterus (x40). Oral sucker