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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0022-3859
Vol. 56, No. 4, 2010, pp. 287-289
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Bioline Code: jp10084
Full paper language: English
Document type: Case Report
Document available free of charge
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Journal of Postgraduate Medicine, Vol. 56, No. 4, 2010, pp. 287-289
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Recurrent cholangitis in the tropics: Worm or cast?
Jain, P. A.; Gandhi, V. V.; Desai, P. & Doctor, N. H.
Abstract
The development of biliary casts is very rare, especially in non-liver transplant patients. The etiology of these casts is uncertain but several factors have been proposed which lead to bile stasis and/or gallbladder hypo-contractility and promote cast formation. Here, we report a 54-year-old male, with diabetes and ischemic heart disease, who presented with recurrent attacks of cholangitis. Magnetic resonance cholangiopancreatography revealed linear T1 hyperintense and T2 hypointense filling defects in the right and left hepatic ducts extending into the common hepatic duct, and a calculus in the lower common bile duct, raising a suspicion of worm in the biliary tree. In view of failed attempts at extraction on endoscopy, patient underwent surgery. At exploration, biliary casts and stones were extracted from the proximal and the second order bile ducts, with the help of intraoperative choledochoscopy and a bilio-enteric anastomosis was accomplished. Although endoscopic retrieval of the biliary cast can be employed as first-line management, surgery should be considered in case it fails.
Keywords
Biliary cast syndrome, intraoperative choledochoscopy, worm infestation
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