2 Interesting cases of Obstructive jaundice discovered

during ERCP:Kurdistan Center for GIT/Hepatology

History:

• 50 yr old female pt., from inside sulaimani city• Presented with gradually increasing jaundice over a

few days• With tea-colored urine• Generalized itching,no fever, or abdominal pain• Normal bowel habit• No relevant symptoms in other systems• No history of same condition before or in her family• History of cholecystectomy before 2 yrs ( gall stone)

PE:

• Jaundice• No pallor• No signs of CLD• NO FEVER• Hemodynamically stable• Soft abdomen,no palpable organs

Treatment while waiting for ERCP:

• CEFOTAXIME VIAL 1gm *2• VITAMIN K AMP. 10 mg every other day.

Fasciola hepatica.

2nd case: intra-biliary rupture of liver hydatid cyst

.

Case Presentation, Hospital course

Side viewing camera

Dilated CBD

Multiple filling defects

Drain at site of

excised cyst

Hydatid disease of the biliary tree Hepatic hydatid disease (HHD) is a major

endemic problem in sheep-rearing regions of the world.

Communication between cysts and the biliary tree is detected at a rate of approximately 20%.

Intrabiliary rupture, which has an incidence of 5-17%, is a common complication of hydatid cysts

Reference : Gastroenterology and hepatology journal

Hydatid disease of the biliary tree

A rupture into the biliary tree can lead to obstruction by the daughter cysts, producing cholangitis.

Imaging techniques are highly sensitive for detecting liver hydatidosis, but usually fail to locate the involvement of the biliary tree.

The presence of a dilated common bile duct (CBD), jaundice, or both, in addition to a cystic lesion on (US) and (CT), are suggestive of biliary hydatid disease (BHD).

Reference : Gastroenterology and hepatology journal

Hydatid disease of the biliary tree

ERCP with endoscopic sphincterotomy and extraction of the cysts from the CBD has emerged as a safe and an effective treatment for patients with intrabiliary rupture of hepatic hydatid cysts. Plus Albendazole.

Surgery is an alternative..

Reference : The internet journal of gastroenterology.