Fasciola hepatica causing acute pancreatitis complicated by biliary sepsis - 23/08/11
Doi : 10.1016/j.gie.2009.04.010
| Commentary F hepatica is a trematode with a worldwide distribution that infects sheep, goats, and cattle as their normal hosts; it has been described on all continents but Antarctica. Humans acquire these parasites by ingesting metacercariae encysted on fresh water plants such as watercress, after which the ingested metacercariae excyst in the small intestine, penetrate the bowel wall, enter the peritoneal cavity, migrate to the liver, penetrate the capsule, and travel through the hepatic parenchyma in search of a bile duct. They reside within the bile ducts for many years, laying eggs that pass with the bile and are excreted with the stool. Fasciola were first documented in soil samples from a cemetery dating back to late Neolithic–Roman Iron Age periods, but their earliest mention is in the French literature by Jean de Grie in 1379 who described the consequences of sheep liver rot in his treatise on sheep management and wool production. Fasciola is derived from the Latin word fascia, for fillet or small bandage; hepatica of course refers to its location in the host. Fasciola infections usually are asymptomatic. In the acute phase, patients can have abdominal pain and hepatomegaly as the parasites penetrate the intestinal wall and hepatic capsule; acute symptoms wane as the parasites enter the bile ducts. During the chronic phase of disease, patients may develop intermittent biliary obstruction and cholangitis, and, rarely, pancreatitis. Diagnosis usually is by finding eggs in the stool, although Fasciola release low numbers of eggs, making this test insensitive; most sensitive is an enzyme-linked immunosorbent assay for antibodies against the worms. Duodenal or biliary aspirates also can demonstrate eggs or, as in this case, the trematode itself, which resembles a mobile leaf. John Burroughs, the American essayist and naturalist (1837-1921), however, would not have thought this leaf to be one that grows beautiful with age and whose last days are full of light and color. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2009
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 70 - N° 2
P. 386-387 - août 2009 Retour au numéro
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