Ascariasis is a helminthic infection of humans caused by the nematode Ascaris lumbricoides. Biliary ascariasis is one of the most common and well described entities caused by ascaris. In endemic areas pregnant women are prone to develop biliary ascariasis. Its management poses a great challenge to both the attending surgeon and the endoscopist. Between January 1993 and March 2003, 15 cases of biliary ascariasis were seen in pregnant patients in our institution. Ultrasonography was used as the main investigative tool. Treatment involved management by conservative, endoscopic, and surgical methods, taking due care of both the mother and the fetus. Ten patients (66.6%) were in the third trimester of pregnancy, and 10 (66.6%) patients were in their third pregnancy. Ultrasonography proved to be the best tool for diagnosing and monitoring worms inside the biliary ductal system. Nine (60%) patients responded to the conservative treatment; endoscopic extraction was successful in 4 (66.6%) patients. Surgical treatment was required in 2 (13.3%) patients. One (6.6%) patient had had spontaneous abortion at 12 weeks gestation, and one (6.6%) patient had a premature labor. The remaining patients had normal pregnancies. Management of biliary ascariasis in pregnancy is a challenge for both the attending surgeon and the endoscopist. Safe and effective management requires special attention to the gestational age and accurate recognition of the specific pathology in the patient. The majority of patients respond to conservative treatment, but endoscopic extraction may be needed in nonresponsive cases. Lead shielding of the fetus and limitation of the total fluoroscopic exposure during therapeutic endoscopy can minimize the teratogenic risk of ionizing radiation. Failures of endoscopic extraction may lead to surgical intervention, which carries risks of fetal wastage and premature labor. Routine worming of women in the child-bearing years is recommended in endemic areas of ascariasis. Though ascariasis is a problem in developing countries, because of increased travel and population migration, clinicians elsewhere should be aware of the problems associated with ascariasis.

Background.The study was aimed at assessing the role of ultrasonography and multidetector computed tomography angiography in evaluating patients with suspected mesenteric ischemia, as well as assessing the effect of the time from presentation to management on mortality and morbidity. Materials and Methods. Patients with clinically suspected mesenteric ischemia underwent Doppler ultrasound and contrast-enhanced computed tomography. On ultrasonography, we assessed any filling defect in the superior mesenteric artery/vein, narrowing or occlusion of the proximal superior mesenteric artery, ascites, bowel wall thickening, and pneumatosis/portal venous gas. Computed tomography angiography was performed looking for any filling defect in the superior mesenteric artery/vein, superior mesenteric artery/vein calibre, bowel wall thickening, calibre and enhancement and pneumatosis/portal vein gas. Most of our patients underwent emergency surgery and the findings correlated with imaging. All the patients were divided into Group A (n=30) and Group B (n=17) based on the time from presentation to management: within 48 hours of presentation and 48 hours after presentation, respectively. Results. On computed tomography scan, mesenteric vascular involvement was seen in 27 (55%) patients, mesenteric/intestinal twist was observed in 12 (25%) patients, and non-occlusive mesenteric ischemia was found in 6% of patients. The computed tomography findings were found to have a sensitivity of 86%, a specificity of 94% and an accuracy of 90% in cases of mesenteric ischemia. Among 35 patients operated on, those presenting within 48 hours, had a significantly less mortality (63%) in comparison to those presenting after 48 hours (90%). Conclusions. Clinical, laboratory and ultrasound features are non-specific in diagnosing mesenteric ischemia. Computed tomography angiography is a sine qua non in mesenteric ischemia diagnosis. Patients with venous ischemia respond well to conservative management. Early intervention within the first 48 hours is associated with better prognosis.