Case of acute cholecystitis in a 47-year-old woman due to taeniasis
Taeniasis is a pathological illness caused by human infection with various species of parasitic tapeworms from the Taenia genus. That includes Taenia solium, Taenia saginata, and Taenia asiatica. These infections are mainly caused by consuming undercooked pork (in the case of T. solium and T. asiatica) or beef (in the case of T. saginata). Furthermore, it contains cysticerci that mature into adult tapeworms within the intestinal tract. Taeniasis is more common in rural regions with poor sewage treatment, close human-animal contact, and eating of raw or undercooked parasitized meat. Although it primarily affects the small intestines. This parasite infection can occasionally spread beyond these organs into extraintestinal locations, such as the appendix, pancreas, liver, and biliary system.
This report is of a rare instance of acute cholecystitis in a 47-year-old lady caused by an infection with T. saginata or T. asiatica.
Case Report
A 47-year-old Thai woman presented to Nan Hospital in northern Thailand with acute abdominal discomfort in the epigastric region. That had begun 6 hours earlier. She also reported having two bouts of nausea and vomiting but no fever or diarrhoea. She denied any history of unusual eating habits or trips outside the nation.
During the physical examination, the patient was fully aware and showed neither pale conjunctivae nor icteric sclerae. An examination of her heart and lungs indicated no abnormalities. However, an abdominal examination revealed significant discomfort in the epigastric and right upper quadrants. There was no involuntary guarding or muscular tightness noted. Examinations of the cerebral, musculoskeletal, and genitourinary systems found no significant abnormalities or signs of distress.
Patients with gallbladder taeniasis may suffer a variety of symptoms or none. The most common symptoms include abdominal pain, nausea, vomiting, and fever. Tapeworm infection can occasionally lead to consequences such as cholecystitis, choledocholithiasis, and pancreatitis.
Investigations
Preoperative laboratory results revealed no anemia or leukocytosis. Differential white blood cell and platelet levels were within acceptable limits. No electrolyte imbalances were detected. However, the patient had modest direct hyperbilirubinemia and transaminitis.
Abdominal ultrasound found evidence of numerous gallstones. A thicker gallbladder wall was also noted. The patient’s liver size seemed normal. These data supported a diagnosis of acute cholecystitis. The patient was given intravenous omeprazole and buscopan to alleviate symptoms. As well as intravenous ceftriaxone as a preoperative antibiotic. An elective cholecystectomy was scheduled for one day following hospitalization to surgically remove the gallbladder.
An Elective Cholecystectomy
During the surgery, a gall bladder measuring 9×3.5×2.5 cm in size and having a smooth serosal surface was resected with no gallstones identified. A tapeworm measuring 70 cm long and 0.8 to 1.0 cm wide was discovered in the gallbladder’s lumen. Histopathology of gallbladder tissue stained with hematoxylin and eosin (H&E) (Figure B) revealed that the wall was edematous. The mucosa showed necrosis and acute inflammation.
After the cholecystectomy, the patient’s abdominal pain was relieved. The attending physician recommended four tablets of niclosamide (500 mg) as an anti-helminthic medication. The patient was discharged on the seventh day after completing surgical treatment.
Discussion
Gallbladder taeniasis, sometimes referred to as gallbladder tapeworm infection. It is an uncommon illness brought on by gallbladder tapeworms. Usually, T. saginata or T. solium tapeworms are the culprits. We looked at the research on gallbladder taeniasis cases. In their description of the first biliary migration of T. saginata. Benedict et al. concluded that the presence of Taenia worms in the biliary channels should be referred to as biliary taeniasis. The biliary or gallbladder tracts are infected by mature Taenia worms that pass via the ampulla. As is common for these parasites. These mature worms may have moved into biliary pathways after the cysticerci were activated before adhering to the wall of the small intestine.
A noninvasive method for finding helminths in the pancreas and biliary system is abdominal ultrasonography. The usefulness of ultrasonography in identifying and treating biliary ascariasis was investigated by Al Absi et al. Because of its high sensitivity and specificity. They concluded that ultrasound is a very useful diagnostic tool for biliary ascariasis. Abdominal ultrasonography in our case showed many gallstones and a thickened gallbladder. According to the ultrasound study, the gallstones that were seen might have been the result of entire helminths combining, which eventually resemble gallstones.
The pathological manifestations linked to gallbladder Taenia spp. can differ. Gallbladder taeniasis, as described in a case by Yu et al, is characterized by multifocal ulceration of the gallbladder mucosa. That is coated in a fibrinoid crust and is accompanied by lymphoplasmacytic cell and eosinophil infiltration. Nevertheless, in our instance, analysis of the cholecystectomy material revealed infiltration of acute inflammatory cells, mucosal necrosis, and an edematous gallbladder wall—all of which were compatible with a diagnosis of acute cholecystitis.
