
==== Front
Gastro Hep Adv
Gastro Hep Adv
Gastro Hep Advances
2772-5723
Elsevier

S2772-5723(24)00080-3
10.1016/j.gastha.2024.06.001
Images of the Month
A Surprise in the Bile Duct
Asavachaisuvikom Ativitch Ativas@kku.ac.th
ativitch12@gmail.com
∗
Pugkhem Pun
Luvira Vor
Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
∗ Correspondence: Address correspondence to: Ativitch Asavachaisuvikom, MD, Department of Surgery, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Mueang District, Khon Kaen 40002, Thailand. Ativas@kku.ac.thativitch12@gmail.com
14 6 2024
2024
14 6 2024
3 6 851852
23 4 2024
4 6 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcA 76-year-old woman complained of abdominal pain that has been persisting for a month. She also mentioned experiencing significant weight loss. The laboratory results indicate a white blood cell count of 5180/uL with eosinophilia. The liver function tests were within the normal limit. The CA19-9 level was 22.48 U/mL. An ultrasound revealed intrahepatic duct dilatation and a hypoechoic lesion in the left lobe of the liver (Figure A). A magnetic resonance imaging scan of the abdomen was conducted, revealing the presence of an intraductal papillary neoplasm of the bile duct (IPNB) in segment IV (Figure B). She underwent left hepatectomy. During the procedure, cholangioscopy was conducted to assess the tumor’s extent. It was discovered that a flat worm was present in the biliary tract, using its oral sucker (Figure C). The surgical specimen showed the presence of papillary lesions (as arrow in Figure D), which were later confirmed to be IPNB through histological examination.

In Northeastern Thailand, Opisthorchis viverrini infection is exceptionally prevalent, especially in rural areas where people often eat undercooked freshwater fish that may contain the infective stage of O viverrini. In addition, there is a significant correlation between O viverrini infection and the occurrence of IPNB.1

Conflicts of Interest: The authors disclose no conflicts.

Funding: The authors report no funding.

Ethical Statement: This article has been reviewed by the Khon Kaen University Ethics Committee for Human Research based on the Declaration of Helsinki and the ICH Good Clinical Practice Guidelines (HE671223).

Reporting Guidelines: CARE.
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Reference

1 Luvira V. Kamsa-ard S. Kamsa-ard S. Association between repeated praziquantel treatment and papillary, and intrahepatic cholangiocarcinoma Ann Hepatol 17 2018 802 809 30145559
