Abstract
A case of multilocular liver echinococcosis is reported. A 58 year old male was in-fected with echinococcus in the northern Kurile islands (Shumushu Is.) at the end of the World War 11(1943. 1 9 4 5). His chief complaints were occasional jaundice, hepatomegaly, and expectoration of bitter bile-stained sputum due to a secondary hepato-pulmonaly fistula, a very rare compli-cation of this disease, which was found in only 3 (1.5%) of 194 cases of multilocular liver echinococcosis in Hokkaido. In this case it needed about 33-35 years after infection until these complaints have appeared. Roentogenograms of the chest and the abdomen disclosed multiple calcified lesions in the lungs and the liver. Immunodiagnostic tests of echinococcus (CFT, IHA, I.E) were all positive and the haemogram showed a high eosinophil count of 30%. ERCP also revealed a stricture of the common bile duct and dilated intrahepatic bile ducts which run upside-down. To our Knowledge, this seems the first ERCP of multilo-cular liver echinococcosis. Biopsy under direct vision of laparoscope was performed from ash-colored, very hard tumor under the right lobe of the liver. The specimen showed cysts with thick chitin membranes characteristic of this disease. Operation for the hepato-pulmonary fistula was successful and surgical biopsy specimen also showed multilocular liver echinococcosis.
