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Year : 2010  |  Volume : 56  |  Issue : 4  |  Page : 287-289

Recurrent cholangitis in the tropics: Worm or cast?

1 Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
2 Department of Medical Gastroenterology, Surat, India

Correspondence Address:
N H Doctor
Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0022-3859.70942

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The development of biliary casts is very rare, especially in non-liver transplant patients. The etiology of these casts is uncertain but several factors have been proposed which lead to bile stasis and/or gallbladder hypo-contractility and promote cast formation. Here, we report a 54-year-old male, with diabetes and ischemic heart disease, who presented with recurrent attacks of cholangitis. Magnetic resonance cholangiopancreatography revealed linear T1 hyperintense and T2 hypointense filling defects in the right and left hepatic ducts extending into the common hepatic duct, and a calculus in the lower common bile duct, raising a suspicion of worm in the biliary tree. In view of failed attempts at extraction on endoscopy, patient underwent surgery. At exploration, biliary casts and stones were extracted from the proximal and the second order bile ducts, with the help of intraoperative choledochoscopy and a bilio-enteric anastomosis was accomplished. Although endoscopic retrieval of the biliary cast can be employed as first-line management, surgery should be considered in case it fails.


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow