Hepatic fascioliasis and biliary surgery

This series represents seven cases of hepatic fascioliasis (HF), two diagnosed as the sequelae of the disease and five showing the parasite itself at the time of the primary surgical intervention. The mean history of the symptoms was 42.6 mths. All of the patients were initially misdiagnosed as having cholecysto- and/or coledocho-lithiasis or hepatitis. Definite diagnosis was established intraoperatively in each instant. At surgery cholecystectomy, choledochotomy with extirpation of the flukes from the biliary tree and T-tube biliary drainage was performed without any complications in five patients. The remaining two patients were suffering from recurrent cholangitic episodes and were regarded as sequelae and therefore treated with hepatic peri-arterial neurectomy with favourable results. Six patients received medical treatment involving emetine hydrochloride. Two patients failed to return for follow-up while others were seen to be well 6, 12, 24 mths and 13 and 24 yrs postoperatively, implying promising long-term results both in the active and chronic stages of HF.