Case Report Diagnosis and management of hepatic fascioliasis mimicking intrahepatic cholangiocarcinoma: a case report

Fascioliasis is a rare zoonotic infection caused by Fasciola hepatica, and presents with atypical clinical manifestations including fever, ambiguous gastrointestinal symptoms and right upper quadrant pain. Blood tests often reveal elevated eosinophilia. However, it may be misdiagnosed as intrahepatic chaolangiocarcinoma on radiologic findings. In this study, we presented a 41-year-old female patient, with a history of taking raw watercress, presented with right upper quadrant pain, fever and eosinophilia. Magnetic resonance imaging (MRI) studies suggested intrahepatic cholangiocarcinoma. Cholecystectomy and left lateral lobectomy was performed. Due to the dilation of the choledochus, the common bile duct was explored using a fiberoptic cholangioscope; and a leaf-shaped worm was found in the lumen of the lower part of the common bile duct. The worm was confirmed as Fasciola hepatica by the Beijing Research Institute of Tropical Medicine. A T-tube was planted in the common bile duct after extraction of the worm using lithotomy forceps. The worm bodies were drained out in the bile through the T-tube for three days after praziquantel tablets were taken. The T-tube was removed two months later. During the 36-month follow-up period after surgical and medical treatment, the symptom of the patient was alleviated. In conclusion, Hepatic fascioliasis should be on the list of differential diagnoses in patients with radiologic findings that mimicking intrahepatic cholangiocarcinoma. Hepatobiliary surgeons should keep in mind the possibility of Fasciola hepatica infection in patients with right upper quadrant pain, fever, eosinophilia and a history of the intake of raw aquatic plants. When abdominal exploration is performed, the placement of a T-tube in common bile duct may drain the worm bodies and prevent the development of biliary obstruction, following anti-helminth therapies.