The liver fluke:Chronic hepatic abscess associated with fascioliasis

The liver fluke Fasciola hepatica has a digenetic lifecycle, requiring water snails as intermediate host. Man becomes an accidental final host after the ingestion of loof – typically watercress – that is contaminated with infectious metacercariae.The metacercariae exist in the human upper gastrointestinal tract, penetrate the intestinal wall, and migrate through the visceral peritoneum, finally boring their way through the liver capsule. The young flukes migrate from the subcapsular parenchyma to the biliary tree were the hermaphrodite adult flatworms can reside for years, giving rise to obstructive jaundice, cholangitis, or cholangiocarcinoma. In many locations such as Portugal, the Nile delta, northern Iran, parts of China, and the Andean highlands of Ecuador, Bolivia, and Peru, infections rates are high enough to make fascioliasis a serious public health concern....read more..

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Hepatobiliary and Pancreatic: Chronic hepatic abscess associated with fascioliasis

T-J Yen1, C-H Hsiao2, R-H Hu3, -L Liu4, C-H Chen1
Article first published online: 17 FEB 2011
DOI: 10.1111/j.1440-1746.2011.06679.x

Journal of Gastroenterology and Hepatology
Volume 26, Issue 3, page 611, March 2011

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A woman, aged 36, had investigations as part of a health screen. She denied any significant symptoms. Although she is currently living in Taiwan, she was born in Burma and had travelled extensively through South East Asia. She had the dietary habit of ingestion of raw vegetables. Screening blood tests including liver function tests were normal. Tumor markers were within the reference range and she had negative serological tests for hepatitis B and C. An ultrasound study showed a large hepatic mass and this was followed by a contrast-enhanced computed tomography scan. There was a lobulated mass, 9 cm in diameter, in the right hepatic lobe that was well-demarcated and showed spotty peripheral calcification. Furthermore, the lesion did not enhance in either the arterial, portal venous or delayed phases.

The portal venous phase is shown in Figure 1.

A liver biopsy showed granulation and necrotic tissue without evidence of malignancy. She was treated with a right hepatectomy. The mass contained granulation-like tissue with turbid yellow fluid. Histological sections revealed several unembryonated eggs, 100–150 µm in maximum diameter, that seemed likely to be related to infection with Fasciola hepatica (Figure 2). She was not treated with antihelminthic drugs as stool specimens were negative for eggs and for Fasciola hepatica antigens.

Figure 1

Figure 2

The three major liver flukes that infect humans are Clonorchis, Opisthorchis and Fasciola. Fasciola has a more complex lifestyle that includes an hepatic phase as well as a biliary phase. In the hepatic phase, developing flukes remain within the liver for 6 to 9 weeks. This phase is often asymptomatic but, with major infections, symptoms can include fever, upper abdominal pain, hepatomegaly and urticaria. Most patients also have a high eosinophil count in peripheral blood. Mature flukes in the bile duct can persist for up to 10 years and are occasionally symptomatic with biliary pain, cholangitis and pancreatitis. The development of a chronic liver abscess appears to be extremely rare but could develop because of prominent hepatic inflammation or because of an unusual chronic form of cholangitis. In the above case, the latter would appear more likely as eggs are only produced by mature flukes within the biliary system. http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06679.x/full

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