Arkoulis Nikolaos, Zerbinis Helen, Simatos Georgios, Nisiotis Athanasios
Department of Plastic Surgery, St. John's Hospital, Livingston, Scotland EH54 6PP, UK.
Int J Surg Case Rep. 2012;3(1):6-9. doi: 10.1016/j.ijscr.2011.10.003. Epub 2011 Oct 19.
Enterobius vermicularis or "pinworm" infection of the liver is an extremely rare condition with only five cases previously reported in literature. It is characterized by the presence of granulomas in the liver with a necrotic core, containing adult helminthes or their ova. Because of the relatively mild symptomatology associated with this disease, prior to the arrival of modern imaging methods hepatic enterobiasis was an incidental intra-operative finding during abdominal surgery for other conditions. In recent years however, with high-resolution abdominal imaging readily available and the improved safety of hepatic resection, a lower threshold for treating suspicious hepatic nodules aggressively with surgery is being adopted.
We present the second case in international literature, where E. vermicularis of the liver was mistaken for malignancy and led to hepatic resection and perform a literature review of the five previously documented cases of hepatic enterobiasis.
Our report identifies certain trends in this condition's aetiology and clinical behaviour, but due to its rarity definitive answers cannot yet be established.
We do not advocate a change in the current approach of suspicious hepatic nodules, but we do feel that better understanding of the mechanisms involved with hepatic enterobiasis could, in the future, prevent unnecessary surgery.
肝蠕形住肠线虫（蛲虫）感染是一种极为罕见的疾病，此前文献仅报道过5例。其特征为肝脏出现肉芽肿，中心坏死，内含成虫或虫卵。由于该疾病相关症状相对较轻，在现代影像学方法出现之前，肝蛲虫病是在因其他疾病进行腹部手术时偶然发现的术中情况。然而近年来，随着高分辨率腹部成像技术的普及以及肝切除术安全性的提高，对于可疑肝结节采取积极手术治疗的阈值正在降低。
我们报告国际文献中的第二例病例，该病例中肝脏的蠕形住肠线虫被误诊为恶性肿瘤并导致肝切除，同时对之前记录的5例肝蛲虫病病例进行文献综述。
我们的报告确定了该疾病病因和临床行为的某些趋势，但由于其罕见性，尚未能得出确切答案。
我们不主张改变目前对可疑肝结节的处理方法，但我们认为，未来更好地了解肝蛲虫病的发病机制可以避免不必要的手术。
