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259 HEPATIC FASCIOLIASIS COMPLICATED BY HEPATIC CYST IN COMMUNICATION WITH THE BILIARY TREE AND SECONDARY SCLEROSING CHOLANGITIS AL Morse, K McClean, A Bedi Infection with the liver fluke Fasciola hepatica is rarely reported in both Canada and the United States. A 27-year-old Caucasian female presented with right upper quadrant pain, hypodense hepatic lesions, and eosinophilia two months after returning from Mexico, where she had adventurous eating habits and recalled watercress ingestion. A diagnosis of hepatic fascioliasis was made on the basis of clinical and radiologic presentation in conjunction with serum antibody testing. After treatment, with triclabendazole, her pain did not fully resolve. Percutaneous drainage of one of the hepatic cysts was performed yielding bilious fluid. ERCP revealed direct communication of the hepatic cyst with a branch of the right hepatic duct and sclerosing cholangitis. A literature review did not identify any other cases of communicating hepatobiliary cyst secondary to Fasciola infection. There have been several reports of secondary sclerosing cholangitis (SSC) after years of chronic Fasciola infection, but none with the patient this close to the acute phase of infection. The hepatobiliary cyst was treated with endoscopic stenting resulting in incremental shrinkage in the size of the cyst as well as improvement in pain. The SSC is asymptomatic, with preserved synthetic function. As the implicated cause of the sclerosis has been identified and corrected it is felt that further progression of the sclerosis is unlikely. There is unlikely to be an increased risk of cholangiocarcinoma in this patient as neither Fasciola infection nor SSC is associated with heightened incidence of malignancy.
University of Saskatchewan, Saskatoon, Saskatchewan