Case of Jaundice. Ahmedabad Gatsro Associates.
8 year old female child Fever, mild abdominal pain and nausea since 4-5 days Seen by paediatrician and advised CBC, SGPT and symptomatic treatment given CBC(2/9/19)- Hb-10.9, WBC- 11700, Plt-1.92, SGPT -1588 On 5/9/19- SGPT was 967 What are likely d/d?.
On 6/9/19 – paediatrician advised for IgM HAV , which was positive. So she was treated as viral hepatitis A on OPD basis.. SGPT(13-9-19)-279 But even after 1 month patient’s symptoms were similar, there was significant tenderness in RHC 14/10/19- s.bil - 0.4, SGPT- 74 What should be done next?.
USG ABDOMEN(14-10-19). 4.4*5.7 cms sized mixed echogenic SOL in right lobe of the liver near porta . No evidence of liquefaction seen. Few enlarged LNs at porta ...
USG abdomen(15/10/19)- 44*29*25mm sized irregular, well defined, thin walled, low echoic structure seen in right lobe of liver near porta . Multiple tubular structures seen within it, s/o hydatid cyst most likely. Similar lesion seen in the liver in the USG done 3-4 months back at same center . Multiple enlarged LNs seen at porta , largest 17*11mm. Patient consulted pediatric Sx , who suggested laparoscopic/open excision of hydatid cyst..
Further story. Relatives were reluctant for surgery Patient came to us on 1/11/2019, abdominal pain persistant , RHC tender, CBD showed leucocytosis(10,100) with eosinophilia(15%). LFT showed mildly increased s.bil (1.8), and SGPT(55). We advised CT scan and MRCP.
CT shows multiple lobulated dhypodense lesions in liver predominantly in subcapsular location with associated irregular tubular tracts along portal vein and its branches s/o organised cholangitis abscesses..
.5 mm 5.2. MRCP s/o non enhancing radiolucent filling defects in mid cbd ?debris..
So it was a case of fasciolopsis hepatica causing obstructive jaundice..