A 45-year-old man presents with recurrent episodes of right upper quadrant pain, fever, and jaundice (Charcot's triad) for the past 6 months. USS shows multiple intrahepatic and extrahepatic bile duct stones. He has no history of gallstone disease. Which investigation is most specific for the underlying aetiology in a patient from a Southeast Asian background?
- A Serology for Echinococcus granulosus
- B Serology for Entamoeba histolytica
- C Serology for Clonorchis sinensis or Opisthorchis viverrini ✓
- D Blood culture for Salmonella typhi
Correct answer: C. Serology for Clonorchis sinensis or Opisthorchis viverrini
Explanation
Recurrent pyogenic cholangitis (oriental cholangiohepatitis) is endemic in Southeast Asia and is strongly associated with hepatobiliary parasitic infestation by liver flukes — Clonorchis sinensis in China/Korea/Vietnam and Opisthorchis viverrini in Thailand — which cause bile stasis, ductal strictures, and intrahepatic stone formation. Echinococcus causes hydatid cysts, not duct stones. Entamoeba histolytica causes hepatic abscesses. Salmonella typhi causes enteric fever and hepatitis but not recurrent cholangitis with ductal stones.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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