A diagnosis of cystic echinococcosis (CE) with two partly calcified hepatic lesions was made in a Turkish patient who immigrated to Germany 38 years ago. One lesion, which was 10 cm × 10 cm, was located in the quadrate lobe close to the gallbladder. The other lesion, which was 4.3 cm × 3.5 cm, was located in the left lobe of the liver. These lesions showed no internal structures and were considered inactive, corresponding to type 5 of the World Health Organization classification.1 The patient had cholecystolithiasis and developed biliary pancreatitis. Laparotomy and cholecystectomy were performed.
Four months later, severe bacteremic cholangitis was diagnosed. Abdominal computed tomography showed cysto-biliary fistula of the echinococcal lesion in the quadrate lobe. The fistula had a diameter of 2.5 cm (Figure 1A, arrow). The choledoch duct was dilated. Endoscopic retrograde cholangiopancreatography demonstrated an amorphous mass discharging into the duodenum after incision of the duodenal papilla (Figure 1B). Microscopic examination of the material showed echinococcal membranes and detritus (Figure 1C). The lesion in the quadrate lobe was then resected and remaining echinococcal material was evacuated from the choledoch duct. Results of a follow-up examination were uneventful. Cystic echinococcosis is a cosmopolitan zoonosis and this clinical image illustrates its most common complication, spontaneous rupture into the biliary tract.2
Address correspondence to Dennis Tappe, Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97067 Würzburg, Germany. E-mail:
Authors’ addresses: Dennis Tappe and August Stich, Department of Tropical Medicine, Medical Mission Hospital, Salvatorstrasse 7, 97067 Würzburg, Germany, E-mails:
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