Abstract Hepatic fascioliasis is a foodborne zoonosis that can mimic hepatobiliary malignancy and occasionally requires surgery when diagnosis is uncertain or when a focal complicated lesion is not amenable to endoscopic or medical management. We report 2 cases managed at a military-associated surgical center in Ukraine involving civilian employees of the Armed Forces of Ukraine working in rear-area, non-combat facilities. Case 1: a 38-year-old man with more than 1 year of right upper quadrant pain and a subcapsular tract-like lesion in hepatic segment VI. Eosinophils and cholestatic enzymes were not elevated. Laparoscopic segment VI resection was performed, and histopathology demonstrated necrotizing inflammation with degenerated Fasciola fragments. Case 2: a 51-year-old woman with nausea, vomiting, back pain, and a brief episode of jaundice; imaging showed a lesion in segment VII extending into segment VI. Preoperative leukocytosis with marked neutrophilia was present, but eosinophil count and full liver biochemistry were not available in the preoperative record. Laparoscopic segment VII resection was performed, and histopathology showed necrotizing inflammation compatible with fascioliasis-related tissue injury. Both patients recovered without postoperative complications and were discharged; triclabendazole was prescribed postoperatively as a precaution. These cases highlight diagnostic pitfalls, including absent or incomplete “classic” laboratory signs, and support laparoscopic resection as a safe option in selected patients when malignancy cannot be excluded and endoscopic therapy is unlikely to succeed, with particular relevance to military health systems.
Husiev et al. (Fri,) studied this question.