Faisal G Bhopal, Nadia Khan, Emran Amir, Muhammad Iqbal, Jahangir Sarwar Khan, Hamid Hassan.
Helminth-induced Biliary Fibrosis.
J Rawal Med Coll Jan ;7(1):45-6.

A young gentleman of 18 years, presented with jaundice, fever and pain in right upper abdomen. A month earlier he started developing jaundice, which was insidious in onset, progressive and associated with passage of dark coloured urine and clay coloured stools. Jaundice was associated with pain in the right upper part of abdomen and epigastrium. He also complained of intermittent fever for the past one month. He was diagnosed as having cholecystitis for which a cholecystectomy was performed 5 months back. There was no history of anorexia, weight loss, body aches, cough, rashes or passage of worms in stool. He had a past history of pulmonary tuberculosis 4 years back for which he had received anti tuberculous therapy. On admission he was afebrile, jaundiced and looked pale. Pulse rate was 88 per minute and B.P. 120/80mmHg. On abdominal examination there was tenderness in right hypochondrium and hepatomegaly. Investigations revealed bilirubin 8 mg/dl and alkaline phosphatase 1268 u/1. Ultrasonography showed hepatomegaly and dilated intrahepatic biliary channels. CT scan revealed intrahepatic biliary duct ectasia with CBD dilatation and a mass in the pancreatic head. A linear stricture was seen at the lower end of common bile duct which was dilated proximally. He underwent surgery with excision of CBD mass, hepatico-jejunostomy and Roux-en-Y enteroenterostomy.

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