04 October 2024: Articles
Acute Cholecystitis Due to Taeniasis: A Case Report of an Unusual Site of or Infection
Unusual clinical course
Kornnatthanai Namsathimaphorn 1ABCDEF, Teerada Daroontum 2CD, Sangob Sanit 3BCDEF, Worawit Aimim-Arnant4BD, Komson Wannasai 2ABCDEFG*DOI: 10.12659/AJCR.944894
Am J Case Rep 2024; 25:e944894
Abstract
BACKGROUND: Taeniasis is a helminthic infection caused by the Taenia species, specifically T. solium, T. saginata, and T. asiatica. Generally, the parasites infect the small intestine; however, instances of atypical migration have also been reported.
CASE REPORT: A 47-year-old Thai woman presented to Nan Hospital with epigastric pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and laboratory analysis revealed mild direct hyperbilirubinemia. Abdominal ultrasonography revealed multiple gallstones and acute cholecystitis. During an elective cholecystectomy, a 70-cm-long tapeworm was found in the gallbladder. Histological examination confirmed the presence of parasitic infection suggestive of Taenia spp., with acute inflammation and focal mucosal necrosis of the gallbladder. Microscopic examination revealed 20 to 22 uterine branches in each of the 5 gravid proglottids, with 42 to 55 uterine twigs and an average ratio of uterine twigs to branches of 2.41, confirming that the parasite in question was possible for T. saginata or T. asiatica. The patient’s symptoms resolved after surgery. She was prescribed an oral antibiotic and antiparasitic drug after the operation and experienced no post-surgical complications.
CONCLUSIONS: Certain parasitic worms can migrate from the intestine to the biliary system. Although less common, T. solium, T. saginata, and T. asiatica can also be detected in the gallbladder and cause acute cholecystitis. This case stresses the potential for misdiagnosis in imaging studies and advises clinicians in endemic areas to consider Taenia spp. infections in the biliary system.
Keywords: Abdominal Pain, Cestode Infections, Cholecystectomy, Gallbladder, Taeniasis
Introduction
Taeniasis is a pathological condition resulting from human infestation with several species of parasitic tapeworm of the
Many individuals infected with
This report describes a unique case of acute cholecystitis in a 47-year-old woman that was caused by a
Case Report
A 47-year-old Thai woman presented to Nan Hospital, located in northern Thailand, with severe abdominal pain in the epigastric region that had started 6 h prior. She also reported experiencing 2 episodes of nausea and vomiting but no fever or diarrhea. She denied a history of strange eating habits or traveling outside the country. The patient was fully conscious during the physical examination, without pale conjunctivae or icteric sclerae. An examination of her heart and lungs revealed no abnormalities. However, abdominal palpation revealed marked tenderness in the epigastric and right upper quadrant regions. No involuntary guarding or muscle rigidity was observed. Examinations of the neurological, musculoskeletal, and genitourinary systems revealed no noticeable abnormalities or signs of distress. Preoperative laboratory findings revealed no anemia or leukocytosis. Differential white blood cell and platelet counts were within the normal ranges. No electrolyte imbalances were observed. Nevertheless, the patient exhibited mild direct hyperbilirubinemia and transaminitis.
Abdominal ultrasonography revealed findings suggestive of multiple gallstones. An increased thickness of the gallbladder wall was also observed. The patient’s liver size appeared normal. These findings were consistent with a diagnosis of acute cholecystitis. The patient was prescribed intravenous omeprazole and buscopan for symptom relief and intravenous ceftriaxone as a preoperative antibiotic. Elective cholecystectomy was scheduled 1 day after admission, to remove the gallbladder surgically.
The resected gallbladder (Figure 1) measured 9×3.5×2.5 cm in size and had a smooth serosal surface. Its mucosa appeared irregular and brown and was covered with tan fibrin. The thickness of the gallbladder wall was measured at 0.5 cm, and no gallstones were identified. A tapeworm measuring 70 cm in length and 0.8 to 1.0 cm in width was found in the lumen of the gallbladder. Histopathology of the gallbladder tissue stained via hematoxylin and eosin (H&E) (Figure 2) revealed that the wall was edematous, and the mucosa exhibited signs of necrosis and acute inflammation. Further examination of sections taken from the parasite (Figure 3) with H&E stain revealed a thick tegument layer, smooth muscle layers, and calcareous corpuscles. The parasite was preserved in 10% formalin solution from the first hospital before being sent to the Department of Parasitology, Chiang Mai University, Chiang Mai, Thailand. Owing to the use of a preservative agent, the specimen hardened and shrank, molecular identification could not be performed, and standard staining procedures could not identify the parasite species. The gravid proglottids were transferred into a microcentrifuge tube of 10% potassium hydroxide to prepare the specimen. These tubes were submerged in a beaker containing distilled water and boiled at 80°C for 3 min. The specimens were submerged in a normal saline solution for 10 min to remove the 10% potassium hydroxide. Next, they were compressed using glass slides wrapped with a rubber band, then submerged in 10% formalin for 12 h to undergo re-fixation and create hard tissue. For staining, the flattened samples were rinsed with tap water for 12 h to remove formalin and then submerged in distilled water for 1 h. Samples were stained with Semichon’s acetic carmine solution and allowed to sit for another 12 h. Excess stain was removed using a hydrochloric acid solution in 70% ethanol for approximately 1 to 2 h. Following this, specimens were dehydrated by immersion in 50% ethanol twice, for 3 to 4 h each time. The process was repeated with 70%, 95%, and absolute ethanol. After dehydration, the specimens were immersed in a xylene solution for approximately 20 min. Finally, the samples were mounted using a resin mounting medium (Entellan new, Sigma-Aldrich: Merck KGaA, Darmstadt, Germany) and allowed to dry at room temperature, creating permanent slides of the
The patient experienced relief from her abdominal pain following the cholecystectomy procedure. The attending physician prescribed 4 tabs of niclosamide (500 mg) as an anti-helminthic drug. The patient was discharged on the seventh day following the completion of postoperative care.
Discussion
Gallbladder taeniasis, also known as gallbladder tapeworm infection, is a rare condition caused by tapeworms in the gall-bladder. It is typically caused by
Patients with gallbladder taeniasis can experience a range of symptoms or none. The most common symptoms are abdominal pain, nausea, vomiting, and fever. Less commonly, tapeworm infection can cause complications such as cholecystitis, choledocholithiasis, and pancreatitis [11,12].
Abdominal ultrasonography is a noninvasive technique for detecting helminths in the biliary system and pancreas [13]. Al Absi et al [14] studied the value of ultrasound for diagnosing and managing biliary ascariasis. They concluded that ultrasound is highly effective for diagnosing biliary ascariasis, owing to its high sensitivity and specificity. In our case, abdominal ultrasonography revealed a thickened gallbladder and multiple gallstones. The ultrasound report showed that the observed gallstones may have actually been the merging of whole helminths, which ultimately resemble gallstones.
Pathological findings associated with
Several methods are used to identify
Northern Thailand has a high prevalence of taeniasis, with
Conclusions
We present the case of a Thai female patient with acute cholecystitis caused by
Figures
Figure 1.. A formalin-fixed gallbladder specimen showing an edematous gallbladder with a tapeworm in the lumen. Figure 2.. (A) Low power magnification of the gallbladder showing mucosal ulceration covered with fibrin exudate (H&E, 40×). (B) High power magnification of the gallbladder showing neutrophil infiltration (red arrowheads) (H&E, 400×). Figure 3.. Microscopic findings of the tapeworm showing a thick tegument layer (red arrow), smooth muscle fibers (blue arrow), and calcareous corpuscles (green arrow). (A) H&E, 40×; (B) H&E, 200×. Figure 4.. The gravid proglottid of the tapeworm (Semichon’s acetic carmine stain) showing uterine branches (black arrow) and uterine twigs (blue arrows).References:
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