PSEUDO-TUMORAL HEPATOBILIARY DISTOMATOSIS DIAGNOSED AFTER ENDOSCOPIC BILIARY SPHINCTEROTOMY (CASE REPORT)

Aims:

The aim is to report an observation of hepatobiliary distomatosis in its pseudo-tumoral form treated by endoscopic sphincterotomy.

Methods:

We report the case of a 53-year-old patient who had cholestatic jaundice and pains in the right hypochondrium for 1 month. Bili-MRI showed intrahepatic and extrahepatic bile duct dilatation and 2 bifocal tumoral processes of the bile ducts. Given the suspicion of a cholangiocarcinoma, an ERCP was performed.

Results:

ERCP showed tight stenosis of retro-pancreatic choledochus with dilatation from the common hepatic bile duct, which is the site of several lacunary images. The endoscopic biliary sphincterotomy and the passage of an extraction balloon allowed to bring back only blackish blood. A naso-biliary drain was put in place and the biliary opacification by this drain had objectified the persistence of incomplete intracholedochal lacunary images. A second ERCP had shown the persistence of lacunary images in the common hepatic bile duct with opacification of a cystic image at segment IV communicating extensively with the main bile duct. The endoscopic biliary sphincterotomy has been enlarged with extraction of several stones and material corresponding to liver flukes. Their extraction led to the diagnosis of pseudotumoral hepatobiliary distomatosis. Serology was positive. Treatment with praziquantel at a dose of 50 mg/kg/day was initiated for 5 days. The immediate evolution was favorable and the haptobiliary ultrasound performed few days later was normal.

Conclusions:

Hepatic distomatosis can be evoked in front of a pseudo-tumoral aspect with the presence of clinical and especially biological presumptive signs. Biliary sphincterotomy has made the diagnosis by allowing the extraction of liver flukes and thus lifting the biliary obstruction.