Lee Ok-Jae, Kim Tae-Hyo
Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea.
J Gastroenterol Hepatol. 2006 Oct;21(10):1631-3. doi: 10.1111/j.1440-1746.2006.03185.x.
Fascioliasis is not common in humans and, furthermore, its ectopic migration into the pancreas is extremely rare. A definitive diagnosis of ectopic fascioliasis is based on the demonstration of flukes in the affected organ. If the flukes invade the parenchyma, however, imaging studies are limited in the detection of worms and surgical identification is required. We encountered a clinical case of probable ectopic pancreatic fascioliasis diagnosed through indirect evidence. A 46-year-old Korean woman was admitted with left upper quadrant pain. She had taken praziquantel for hepatic fascioliasis, which had been diagnosed at another hospital, and then developed abdominal pain. Peripheral eosinophilia, hyperamylasemia and hyperlipasemia were documented. Abdominal computed tomography (CT) revealed multiple, hypodense foci which had coalesced, forming irregular nodules in the medial and lateral segments of the left lobe of the liver, and similar 2- to 3-cm sized, hypodense lesions in the body and isthmus of the pancreas. IgG antibody against Fasciola hepatica was positive. Bithionol was given orally, and the patient's symptoms and biochemistry then improved, with reversal of eosinophilia. Radiological studies showed normalization of the liver and pancreas at the 10th week, and the serology for Fasciola hepatica was negative at the fifth month.
肝片吸虫病在人类中并不常见，此外，其异位迁移至胰腺极为罕见。异位肝片吸虫病的确诊基于在受累器官中发现吸虫。然而，如果吸虫侵入实质，影像学检查在检测虫体方面存在局限性，需要手术识别。我们遇到了一例通过间接证据诊断为可能的异位胰腺肝片吸虫病的临床病例。一名46岁的韩国女性因左上腹疼痛入院。她曾因在另一家医院诊断出的肝片吸虫病服用过吡喹酮，随后出现腹痛。记录到外周血嗜酸性粒细胞增多、高淀粉酶血症和高脂肪酶血症。腹部计算机断层扫描（CT）显示多个低密度灶融合，在肝左叶的内侧和外侧段形成不规则结节，以及在胰腺体部和峡部有类似大小为2至3厘米的低密度病变。抗肝片吸虫的IgG抗体呈阳性。口服硫双二氯酚后，患者的症状和生化指标随后改善，嗜酸性粒细胞增多症得到逆转。放射学研究显示第10周时肝脏和胰腺恢复正常，第五个月时肝片吸虫血清学检查呈阴性。
