Biliary Obstruction Caused by Fasciola hepatica Associated with Cholelithiasis: A Case Report

Abstract

Aims: Human biliary fascioliasis is an uncommon zoonotic infection in which humans are accidental hosts. Its coexistence with cholelithiasis is extremely rare and may mislead the diagnostic process. This report describes a rare case of obstructive jaundice secondary to choledochal Fasciola hepatica associated with lithiasic cholecystitis and reviews international reports published from 2015 to 2021. Presentation of Case: A 49-year-old male farmer presented with a three-month history of biliary colic. Laboratory tests showed a cholestatic pattern with hyperbilirubinaemia and no eosinophilia. Ultrasonography and magnetic resonance cholangiopancreatography (MRCP) suggested cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a dilated common bile duct with a distal filling defect. Sphincterotomy and balloon sweeping successfully extracted microliths and an adult spindle-shaped parasite macroscopically compatible with Fasciola hepatica. Laparoscopic cholecystectomy was subsequently performed. The patient had a favourable clinical outcome after albendazole therapy. Discussion: Biliary obstruction caused by adult flukes may clinically and radiologically mimic choledocholithiasis. The literature review identified 26 international cases from 2015 to 2021, with Turkey, Iran and India reporting the highest number of cases. Concomitant cholelithiasis was documented in only three previously reported cases, highlighting the diagnostic difficulty of this parasitic association. ERCP allowed direct diagnosis and minimally invasive management in the present case. Conclusion: Biliary fascioliasis should be considered in the differential diagnosis of obstructive jaundice in patients from endemic or rural settings, even when gallstones are present and eosinophilia is absent.