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Eleven patients were documented as having opisthorchiatic solitary intrahepatic cyst by roentgenography--P.T.C., identification of opisthorchis ova in the bile during P.T.C. and operation. This clinical entity should be differentiated from other forms of intrahepatic cyst. We believe that it is an acquired form. The formation of opisthorchiatic solitary intrahepatic cyst is related to lower biliary tract obstruction and high pressure in the biliary system. Fever, pain in the right upper quadrant and jaundice are the major manifestations of opisthorchiatic solitary intrahepatic cyst. Surgical intervention is the therapeutic method.

Cholangiocarcinoma is the leading cause of cholestasis among patients with malignant tumors, 63.5 per cent, while carcinoma of the head of the pancreas is the most common cause in western countries. A clinical history of progressive cholestasis; signs and symptoms of cholestasis; slow progressive clinical course, and mostly importantly, 96.7 per cent stemming from an endemic area of opisthorchiasis are all shown in this study. The peak age for this disease in Thailand was about one decade younger than that in western countries. The anatomic lesions in 96.7 per cent were found in the hilar area of the liver and only 3.3 per cent in the lower third of the liver compared with a significant number of lesions in the middle and lower thirds of the liver, as reported in literature from the western countries. We believe that percutaneous transhepatic cholangiography prior to the operation will definitely help the surgeon in deciding upon the surgical approach. Surgical intervention of a cholangiocarcinomatous lesion is probably more difficult in Thailand than in western countries because of location. The incidence for cholangiocarcinoma associated with biliary calculi and for an opisthorchiatic cyst is 8.1 and 6.1 per cent. We would like to emphasize the close association between cholangiocarcinoma and the combination of opisthorchiasis with carcinogenic agents, such as nitrosamines in the favorite local dish. The animal experimental model, using Syrian golden hamsters, produced the same result and the same site for the lesion--the hilar area of the liver.

One hundred and eighty-nine patients were documented as having biliary tract disease. Two hundred and nine lesions were found. The prevalence of malignant disease of the biliary tract was represented by 30.1 per cent, and cholangiocarcinoma was a leading cause. The carcinogenesis of cholangiocarcinoma has been speculated. Acute cholecystitis represented 55 per cent of biliary tract disease in Thailand, which consisted of acute calculous cholecystitis and acute noncalculous cholecystitis, 94.8 and 5.2 per cent, respectively. Among acute calculous cholecystitis, the prevalence of cholelithiasis, choledocholithiasis and intrahepatic stones were 58.5, 68.8 and 15.6 per cent, respectively. The high prevalence of choledocholithiasis and intrahepatic stones requires elucidation. In the remaining surgical disease of the biliary tract, opisthorchiatic cyst was the most common cause. The diagnosis of opisthorchiatic cyst was made roentgenologically in association with the identification of Opisthorchis ova in the aspirated bile. Opisthorchiatic cyst appears to be a unique clinical entity, differing from other types of intrahepatic cysts. Another form of presentation of biliary tract opisthorchiasis is through obstruction of the common bile duct by an aggregated mass of dead worms. This condition is cured by surgical removal of the worms. It is worth while to mention that, among 189 patients with biliary tract disease, there were three documented instances of choledochal cysts. This probably indicates a high prevalence of choledochal cysts when compared with that for the United States. In the present study, a 36 year old female with a diagnosis of Caroli's disease, ascariasis of the common bile duct and choledocholithiasis is presented.