Case of Jaundice

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Case of Jaundice. Ahmedabad Gatsro Associates.

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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?.

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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?.

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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 ...

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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..

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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.

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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..

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.5 mm 5.2. MRCP s/o non enhancing radiolucent filling defects in mid cbd ?debris..

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So it was a case of fasciolopsis hepatica causing obstructive jaundice..

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ASSOCIATES AHMEDABAD.