Abstract
A 58-year-old man was admitted to the hospital because of diarrhea and epigastric pain. Complete blood count disclosed an increase of WBC to 13400/mm3. Cholelithiasis was diagnosed by drip-infusion cholangiography, abdominal echography and abdominal CT. Choledochotomy was performed, because perioperative cholangiography following cholecystectomy revealed irregularity of its wall. Then, 28 blackish-brown, flat and small stone-like substances measuring 4×10 mm emerged from the duct. Choledochoduodenostomy was performed by side to side anastomosis. The gallbladder contained one stone measuring 0.7×1×1 cm and six small stone-like substances measuring 4×10 mm. Postoperatively, these small stone-like substances were identified as clonorchis sinensis by microscopic findings.
Its ova were detected by stool examination (MGL method). An anthelmintic (Biltricide, 41.4 mg/kg/day) was administered from the 17th postoperative day. The patient recovered well and was discharged on the 42nd day after operation.
On postoperative investigation of his dietary habit in detail, it was found that he had a habit of eating sliced meat of a carp (washed in cold water) a few times/year. Eating slices of raw fish is a very common and frequently-practiced habit of the Japanese. Therefore, close examination is necessary with likelihood of clonorchiasis in mind, when patients are suspected to have bile duct diseases.
