Biliary ascariasis – A vicious cycle

Abstract

Biliary ascariasis is a rare disease in a non-endemic area. However, it is one of the possible etiological factors for retarded growth as well as malnutrition in children. It may cause intestinal obstruction, appendicitis, biliary obstruction, liver abscess, hepatolithiasis, and pancreatitis in adults. Herein, we report a patient with ascending cholangitis secondary to biliary ascariasis who was successfully managed with Endoscopic Retrograde Cholangio Pancreaticography.

Diagnosis of Asymptomatic Biliary Ascariasis by Abdominal Ultrasound in a Non-Endemic Area

“…All patients with ascariasis need anthelmintic treatment, even those with asymptomatic infection [1,3].…”

“…In biliary ascariasis cases, if conservative medical treatment fails to eradicate the infection, endoscopic retrograde cholangiopancreatography and surgery are the treatments of choice [1,3]. Nevertheless, mortality is low, and the prognosis is good, especially if a correct and timely diagnosis is made [5].…”

“…Ascariasis is caused by Ascaris species, mainly Ascaris lumbricoides [1]. It is the most common helminthic infection worldwide [2][3][4], affecting at least 25 to 33% of the world population [3,5,6].…”

“…Transmission occurs primarily via ingestion of water or food contaminated with Ascaris eggs [ 1 ]. Most patients have asymptomatic infection [ 3 ].…”

A Case Report on Biliary Ascariasis

“…Humans are infested by ingestion of ova-contaminated food and water. Gastric acid then stimulates the mature ova to hatch into larvae that migrate and invade various parts of the body including the cecum, liver, pancreas and lungs [1,2]. Most patients are asymptomatic; however, hepatobiliary disease can present with complications of biliary obstruction like biliary colic, acute cholangitis, acute cholecystitis, and acute pancreatitis, especially in those with a large worm load [3].…”