Surgical Treatment of Hepatic Fascioliasis in Two Civilian Employees of the Armed Forces of Ukraine: A Case Report.
Andrii V Husiev, Oleksii O Popov, Mark E Krol et al.
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Case in brief
Two civilian employees of the Armed Forces of Ukraine presented with hepatic lesions and symptoms including right upper quadrant pain, nausea, vomiting, back pain, or transient jaundice. Imaging showed focal lesions in the right hepatic lobe; laboratory findings did not provide typical support for fascioliasis, with eosinophilia absent in one patient and unavailable in the other. Laparoscopic liver resections were undertaken because malignancy could not be excluded. Histopathology showed necrotizing inflammation, with degenerated Fasciola fragments in one case and changes compatible with fascioliasis in the other. Both patients recovered without postoperative complications and received triclabendazole as a precaution.
What made this case unusual
Fascioliasis presented as focal hepatic lesions concerning for malignancy despite absent or incomplete classic laboratory findings, including no eosinophilia in the patient whose count was available.
Diagnostic / clinical pearl
A focal hepatic lesion suspicious for malignancy may represent fascioliasis even when eosinophilia or other typical laboratory clues are absent or unavailable; histopathology can establish the diagnosis after resection.
Why it matters
The report illustrates that laparoscopic resection may be used in selected patients when malignancy remains uncertain and endoscopic therapy is unlikely to succeed.