An infective cause of obstructive jaundice

A 48-year-old mason, smoker and alcoholic came with complaints of yellowish discolouration of eyes with high coloured urine and pale stools for 15 days. The patient also had abdominal pain that increased on food intake and dyspnoea on exertion. The patient also had anorexia and significant weight loss. On examination, icterus was evident. The blood pressure was 70/50 mm Hg, features of shock were present. Leucocytosis with left shift was observed with conjugated hyperbilirubinaemia was present. Abdominal ultrasonography showed a cystic lesion with peripheral calcification. Contrast-enhanced computed tomography revealed stage 2 hydatid cyst with dilatation of common biliary duct (CBD), right hepatic duct (RHD) and left hepatic duct (LHD) and intrahepatic biliary radicles due to compression at the confluence of RHD and LHD. Endoscopic retrograde cholangio-pancreatography showed a dilated CBD with multiple filling defects and membranes on balloon sweepage. CBD Stenting was done. Patient's general condition improved and was taken up for surgery.