MurugeshMetalEndoscopicextractionofFasciolopsisbuskiEndoscopy200638E129A20yearoldmarriedprimigravidapresentedwithahistoryofepigastricdiscomfortnauseaandvomitingfor3daysOnthedayofadmission ID: 954512
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This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. MurugeshMetal.EndoscopicextractionofFasciolopsisbuski´Endoscopy2006;38:E129A20-year-old,married,primigravidapresentedwithahistoryofepigastricdis-comfort,nausea,andvomitingfor3days.Onthedayofadmission,shegaveahis-toryofvomitingupa3±4-cm,pear-shaped,reddish-brownworm,whichmovedforafewsecondsafteritwasvom-itedandthendied.Onfurtherenquiry,thepatientgaveahistoryofconsumptionofvegetablesthathadbeenwashedinpondwater.Uppergastrointestinalendoscopyre-vealedareddish-brown,flatwormstuckinthesecondpartoftheduodenum(Fig-ure1,Video1)Thewormwasextractedwiththehelpofbiopsyforcepsunderen-doscopicguidance.Thewormwas4cmlong,2cmwide,andabout0.25cmthick,reddish-brown,flattenedanteroposteri-orly,andpear-shaped,withnoprominentorobviouscephaliccone,andresembledthefasciolopsisbuskifluke(Figure2).His-topathologicalexaminationofthespeci-menconfirmeditasF.buski.Routinein-vestigationsrevealedanormalperipher-al-smeareosinophilcount.Stoolexami-nationdidnotrevealanyF.buskieggs.Thepatientwastreatedwithpraziquantel25mg/kgasasingledose.Thepatientwasasymptomaticanddoingwellonfollow-up.Toourknowledge,thisisthefirstreportdescribingandillustratingtheendoscopicremovalofF.buskifromtheduodenumusingforceps.Fasciolopsisandotherfood-bornetrematodeinfectionsarein-cludedinthelistofimportanthelmin-thiasesthathaveagreatimpactonhu-mandevelopment.Currentchangesinglobalweatherpatternsappeartobein-creasinglyaffectingsnail-bornehelmin-thiases,whicharestronglydependentonenvironmentalfactors.Fasciolopsisisagoodexampleofaparasiticdiseasethatisemerging(orre-emerging)inmanycountriesasaconsequenceofchangesinbothenvironmentalandhumanfactors[1,2].Unfortunately,despitecontrolpro-grams,F.buskistillremainsapublichealthprobleminendemicareasandinareaswhereitwasoncethoughttohavebeencontrolled[3,4].Thoughthediseaseisseenpredominantlyinsouth-eastAsia,theendoscopicimageofF.buskiwehaveincludedheremaybeofinteresttotherestoftheworldbecauseofimmigration,globalization,andtheincreasedfrequencyofintercontinentaltravel.Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AZEndoscopy_UCTN_Code_TTT_1AO_2ANM.Murugesh1,S.Veerendra1,S.Madhu1,S.Kude1,A.D.Amrapurkar2,U.U.Rathi1,P.M.Rathi11DepartmentofGastroenterologyandHepatology,BYLNairCharitableHospitalandTNMedicalCollege,Mumbai,India2DepartmentofPathology,BYLNairCharitableHospitalandTNMedicalCollege,Mumbai,India.References1Mas-ComaS,BarguesMD,ValeroMA.Fa-scioliasisandotherplant-bornetrematodezoonoses.IntJParasitol2005;35:1255±12782BhattiHS,MallaN,MahajanRC,SehgalR.fasciolopsiasis±are-emerginginfectioninAzamgarh(UttarPradesh).IndianJPatholMicrobiol2000;43:73±763WorldHealthOrganization.Foodbornetrematodeinfections.BullWHO1995a;73:397±3994WorldHealthOrganization.Controloffood-bornetrematodeinfections.WHOTechRepSer1995b;849:1±157CorrespondingauthorP.M.Rathi,MDDepartmentofGastroenterologyandHepatologyBYLCharitableNairHospitalandTNMedicalCollegeDr.ALNairRoadMumbaiCentralMumbaiMaharastra400008IndiaFax:+91-22-23021168Email:rathipm@hotmail.com EndoscopicextractionofFasciolopsisbuski DOI:10.1055/s-2006-945154 Video1Uppergastrointestinalendoscopy,showinglive,mobileF.buskiinthesecondpartoftheduodenum.Thewormwasextractedusingbiopsyforceps. Figure2TheendoscopicallyextractedF.buskiwormwas4cmlong,2cmwide,andabout0.25cmthick. Figure1Endoscopicviewoffasciolopsisbus-kistuckinthesecondpartoftheduodenum. UCTN UnusualcasesandtechnicalnotesE129