Obstructive Jaundice Induced by Taeniasis

Arham Arsyad, Mappincara, Ibrahim Labeda

Digestive Surgery. Department Of Surgery. Hasanuddin University

Obstructive jaundice occurs when the intra and extra hepatic bile ducts
are obstructed and bile produced by normal liver cells cannot be
excreted. Causes of obstruction can occur due to stones, tumors,
infection, stricture of the sphincter papilla vater, bile strictures, trauma,
amoebic abscess in certain locations, duodenal diverticula, and worms.
Gallstones are a combination of several elements that form a stone-
like material that can be found in the gallbladder (cholesystolithiasis)
or in the bile ducts (choledocholithiasis) or both.1,2,3,4,5
The incidence of choledocholithiasis in western countries is 20%, while
the incidence in Indonesia is not much different from other countries in
Southeast Asia. An increased incidence of gallstones can be seen in the
high-risk group called the “4 F”: female, fertile-especially during
pregnancy, fat (fat), and forty (forty years).2
Worldwide, approximately 1.5 billion people are infected with worms
in the digestive tract. Asia, Africa, Central America and South America
are still endemic areas. Worms in the gallbladder are less common
than worms in the bile ducts. In Indonesia there is no definite incidence
rate. Suzantra, et al in Bandung, 1992-1994 out of 95 cases of
obstructive jaundice only got 3 cases of obstructive jaundice due to
worms.3.7
The treatment of choice for obstructive jaundice is either conventional
surgery or laparoscopic surgery. Surgery is the main treatment.

- Clinical finding- - Intra operative finding -

Female, 42 years old, ethnic Makassar,
housewife, admitted to hospital with chief
complaint of right upper abdominal pain
that has been felt since 7 days ago, pain is
intermittent, pain is felt through the back .
The patient complained of nausea, vomiting,
and fever since 2 days ago. The patient also
complained of intermittent yellow eyes in the
last 3 months.history of putty white stools.
There is a history of yellow urine like tea.
There is a history of consuming large
amounts of fatty foods.
History of weight loss of more than 10 kg in
the last 6 months was denied. There is no
family history of the same disease.
Figure 1. Ultrasonografi finding
Dilated of Main Bile duct and found echo stone size
0.9 cm in Gall Bladder.
In this case, it was found that the stones in the
CBD were thought to be secondary stones with
pigment stones with a diameter of ± 1 cm and
worms with a size of ± 10 cm. In obstructive
- Subheading - jaundice occurs: direct and total bilirubin
increases, cholesterol increases, alkaline
phosphatase increases 2-3 times, gamma
glucuronyl transferase increases, Bilirubinuria
(bilirubin in urine, urine like tea), and stool
alkolis (white stools like putty).
Examination of worms is carried out by
Figure 2. CT Abdominal examining feces by:10 a. Macroscopically, what
Intrahepatic and extrahepatic cholestatic bile ducts is noticed in this case is the shape of the
were seen distal to CBD, no stones or masses were proglottids that come out with the feces. The
identified.
shape is quite distinctive, namely a flat
- Investigations-
rectangle and grayish white in color.
Blood tests were conducted which revealed
little other than a leucocytosis
(15.3×109/l) with a neutrophilia of
89%.Other results of interest include a
reduced albumin (2.7g/dl) and a slight
hypokalaemia (3.3 meQ/l). The most
significant results, however, were with
regards to bilirubin levels. Total bilirubin
was elevated at 2.71 mg/dl; indirect
bilirubin was raised slightly (0.92 mg/dl) Figure 3.
and direct bilirubin was raised markedly Intraoperative finding, seen single stone in Main Bile
(1.88 mg/dl ) duct with .

Worldwide, approximately 1.5 billion people are infected with
worms in the digestive tract. Asia, Africa, Central America and South
America are still endemic areas. Worms in the gallbladder are less
common than worms in the bile ducts.3 Worms in the biliary tract is one
type of helminth infection. In Indonesia there is no definite incidence
rate. Suzantra, et al in Bandung, in 1992-1994 out of 95 cases of
obstructive jaundice only got 3 cases of obstructive jaundice due to
worms.7
Adult worms that live in the small intestine will migrate to the
duodenum and then enter through the ampulla of Vater. So that
clinical symptoms arise caused by worms in the biliary tract, which can
be: acute abdominal pain, vomiting, jaundice from mild to severe
according to the severity of the obstruction.12
In this case, it was found that the stones in the CBD were thought to be
secondary stones with pigment stones with a diameter of ± 1 cm and
worms with a size of ± 10 cm. In obstructive jaundice occurs: direct
and total bilirubin increases, cholesterol increases.
Examination of worms is carried out by examining feces by:10 a.
Macroscopically, what is noticed in this case is the shape of the
proglottids that come out with the feces. The shape is quite
distinctive, namely a flat rectangle and grayish white in color.
Treatment options can be conservative and surgical. Conservative
treatment is performed on patients who refuse surgery or patients
whose surgical treatment cannot be performed. Surgery can be
performed CBD exploration (Common Bile Duct) and laparoscopic
cholecystectomy. In this case, CBD exploration was carried out. In
this operation, cholecystectomy and choledocolithotomy were
performed. After the operation, the patient was given deworming
medicine and Taenia Saginata. Management of Taenia saginata is
medical:10 with Praziquantel : dose 10 mg/kg BW/day in 3 times
for 15 days, or Mebendazole: dose 600-1200 mg for 3-5 days
References
1. Schwartz SI. Manifestations of Gastrointestinal Disease. In: Principles of Surgery fifth edition, editors: Schwartz, Shires, Spencer.
Singapore : McGraw Hill, 2017. 1091-1099
2. Sjamsuhidayat R, de Jong W. Cholelithiasis. In: Textbook of Surgery. Edition 1. 2015. Jakarta: EGC Medical Book Publisher. 767-73.
3. Sarr, Michael G; Cameron, John. Bile System, in Sabiston, David C, Textbook of Surgery, Jakarta: EGC 1994, pp. 115-161
4. Hunter JG. Gallstone's Disease. In : Schwart's Principles of Surgery 8th editions. 2017. US : McGraw-Hill Companies.