Yılmaz Sezgin, Akıcı Murat, Şimşek Merih, Okur Nazan, Erşen Ogün, Tuncer Ahmet Ali
Department of General Surgery, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey.
Department of Microbiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey.
Turk J Surg. 2018 Jan 3;34(4):306-310. doi: 10.5152/turkjsurg.2017.3808.
Endoscopic retrograde cholangiopancreatography may be useful in the diagnosis and management of biliary system parasites.
Investigators retrospectively evaluated patients with biliary system parasites who underwent endoscopic retrograde cholangiopancreatography procedures over an eight-year period. We collected data regarding patient demographics, clinical features, and parasite type. We aimed to determine the utility of endoscopic retrograde cholangiopancreatography as a diagnostic and therapeutic intervention in patients with biliary system parasites.
We identified 22 patients with biliary system parasites from a total of 3,450 endoscopic retrograde cholangiopancreatography procedures performed during an eight-year period. Parasite types included Echinococcus granulosus (n=19), Fasciola hepatica (n=2), and Ascaris lumbricoides (n=1). Fifteen patients with liver hydatid cysts underwent endoscopic retrograde cholangiopancreatography prior to surgery due to obstructive jaundice. The endoscopic retrograde cholangiopancreatography procedure enabled definitive treatment without the need for surgery in the remaining two patients. Two patients with fascioliasis underwent endoscopic retrograde cholangiopancreatography due to clinical presentation of cholangitis, cholecystitis, and obstructive jaundice, leading to presumptive diagnosis of cholangiocarcinoma. However, the final diagnosis was made using endoscopic retrograde cholangiopancreatography following inspection of flat, leaf-shaped, motile flukes extracted from the bile duct. In one patient with ascariasis, a longitudinal tubular structure was identified in the bile duct; emergency surgery was required.
The diagnosis of parasitic diseases is clinically challenging, and definitive diagnosis requires endoscopic retrograde cholangiopancreatography in some cases. Moreover, endoscopic retrograde cholangiopancreatography provides a therapeutic option for ascariasis, fascioliasis, and some forms of hydatidosis. Accordingly, the use of endoscopic retrograde cholangiopancreatography may change preoperative management and treatment strategies for biliary system parasite infections.
内镜逆行胰胆管造影术在胆道系统寄生虫病的诊断和治疗中可能具有重要作用。
研究人员回顾性评估了在八年期间接受内镜逆行胰胆管造影术的胆道系统寄生虫病患者。我们收集了患者的人口统计学数据、临床特征和寄生虫类型。我们旨在确定内镜逆行胰胆管造影术作为胆道系统寄生虫病患者诊断和治疗干预措施的效用。
在八年期间进行的总共3450例内镜逆行胰胆管造影术中，我们识别出22例胆道系统寄生虫病患者。寄生虫类型包括细粒棘球绦虫（n = 19）、肝片吸虫（n = 2）和蛔虫（n = 1）。15例肝包虫囊肿患者因梗阻性黄疸在手术前行内镜逆行胰胆管造影术。内镜逆行胰胆管造影术使其余两名患者无需手术即可得到确定性治疗。两名肝片吸虫病患者因胆管炎、胆囊炎和梗阻性黄疸的临床表现接受内镜逆行胰胆管造影术，初步诊断为胆管癌。然而，在检查从胆管中取出的扁平、叶状、活动的吸虫后，最终通过内镜逆行胰胆管造影术做出诊断。在一名蛔虫病患者中，在胆管中发现了一个纵向管状结构；需要进行急诊手术。
寄生虫病的诊断在临床上具有挑战性，在某些情况下明确诊断需要内镜逆行胰胆管造影术。此外，内镜逆行胰胆管造影术为蛔虫病、肝片吸虫病和某些形式的包虫病提供了一种治疗选择。因此，内镜逆行胰胆管造影术的应用可能会改变胆道系统寄生虫感染的术前管理和治疗策略。
