J Korean Med Sci.  2011 Jan;26(1):135-137. 10.3346/jkms.2011.26.1.135.

Obstructive Jaundice Caused by Clonorchiasis-associated Duodenal Papillitis: A Case Report

• Lim JU
• Joo KR
• Shin HP
• Cha JM
• Lee JI
• Lim SJ

• KMID: 1777988
• DOI: http://doi.org/10.3346/jkms.2011.26.1.135

Abstract

We describe an unusual presentation of Clonorchis sinensis infection with obstructive jaundice due to duodenal papillitis which was relieved dramatically by endoscopic sphincterotomy. A 26-yr-old male presented with complaints of fatigue, weight loss and painless jaundice. The history was significant for frequent ingestion of raw freshwater fish. The patient underwent endoscopic retrograde cholangiopancreatography for evaluation of obstructive jaundice. The duodenal papilla was markedly edematous with a bulging configuration and hyperemic changes at the orifice. Cholangiography revealed mild bile duct dilatation and irregular wall changes with multiple indentations. However, there were no biliary stricture or stones noted as the cause of obstructive jaundice. We performed an endoscopic sphincterotomy for effective bile drainage through the duodenal papilla. After the sphincterotomy, the patient's jaundice was dramatically improved. Pathology of the duodenal papilla showed eosinophilic infiltration of the mucosa. Parasitic eggs, consistent with the diagnosis of C. sinensis, were found in the bile sample.

Keyword

Jaundice, Obstructive; Ampulla of Vater; Clonorchis Sinensis; Sphincterotomy, Endoscopic

MeSH Terms

Adult
*Ampulla of Vater
Animals
Anthelmintics/therapeutic use
Bile/parasitology
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis/*diagnosis/parasitology/pathology
Clonorchiasis/*diagnosis
Clonorchis sinensis/drug effects/isolation & purification
Duodenum/pathology
Humans
Jaundice, Obstructive/*diagnosis/etiology
Male
Praziquantel/therapeutic use
Sphincterotomy, Endoscopic
Tomography, X-Ray Computed

Figure

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  Fig. 1 CT findings of the abdomen. (A) A coronal image shows mild dilated intrahepatic bile duct of the right hepatic lobe (arrows). (B) An axial image shows dilated intrahepatic bile duct of the left hepatic lobe (arrowheads).

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  Fig. 2 Duodenoscopy shows edematous and bulging duodenal papilla with hyperemic orifice.

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  Fig. 3 Endoscopic retrograde cholangiography shows mild bile duct dilatation with multiple ductal irregularities and indentations (arrows).

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  Fig. 4 Pathological findings of the biopsy specimen show many eosinophilic cells in the lamina propria of the mucosal layer (H&E, × 400).

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  Fig. 5 Eggs of C. sinensis are found in the bile fluid sample (Pap, × 200), inset, × 400.

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