Biliary ascariasis: Report of a complicated case and literature review

Sanai, Faisal M; Al-Karawi, Mohamed A.

doi:10.4103/1319-3767.30462

Cited by 36 publications

(45 citation statements)

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“…Clinical signs depend on where the worm migrates: if it reaches the gall bladder—cholecystitis, and if it travels to the bile duct or pancreatic duct—cholangitis or pancreatitis, respectively, can be seen. Presentations of forms are biliary colic (56%), acute cholangitis (25%), acute cholecystitis (13%) and acute pancreatitis (6%), and, rarely, hepatic abscess or haemobilia 12. Furthermore, there are reports of duodenal perforation caused by ascariasis.…”

Section: Discussionmentioning

confidence: 99%

Ascariasis of the pancreatic duct

et al. 2015

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Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.

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Section: Discussionmentioning

confidence: 99%

Ascariasis of the pancreatic duct

et al. 2015

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“…Liver abscess due to ascariasis is indeed a rare, though a known entity, constituting about 1% of total cases of hepatobiliary ascariasis; however, the incidence may be higher in endemic areas. [6] Most of the cases have been diagnosed during surgery or autopsy, but reports on aspiration cytology are sparse. In our case, the patient had both a liver abscess containing ascaris eggs and gall bladder ascariasis.…”

Section: Discussionmentioning

confidence: 99%

Radio-pathological diagnosis of hepatobiliary ascariasis: A rare entity

Chakrabarti

Giri

et al. 2011

J Cytol

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Ascariasis is the commonest helminthic infection in humans, caused by the nematode Ascaris lumbricoides. The adult worms usually reside in the small intestine. Rarely, they migrate into the bile duct and pancreatic ducts, but involvement of the gall bladder and/or liver parenchyma is extremely rare. Here, we describe a case of a 32-year-old woman who presented with fever, anorexia, right upper quadrant pain and mild hepatomegaly. Ultrasonography revealed a liver abscess and a concurrent moving adult worm in the gall bladder. Fine-needle aspiration cytology (FNAC) from the liver abscess showed presence of fertilized eggs of Ascaris lumbricoides. A diagnosis of gall bladder and hepatic ascariasis was made. The patient responded well to conservative management. Ascaris-induced liver abscess with concurrent living adult worm in gall bladder has rarely been reported. Ultrasonography and FNAC are important diagnostic modalities for detection of such lesions. Conservative management appears to be the treatment of choice for hepatobiliary ascariasis.

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“…Intervention is required in a small number (<25%) of patients under the following circumstances: (1) those critically sick with pyogenic cholangitis or unresolving cholecystitis; (2) worms fail to leave the biliary tree within four weeks as by that time they are presumed to be dead and need extraction; (3) worms coexisting with stones; (4) associated liver abscess. [21] Endoscopic extraction of worms from the bile duct with or without sphincterotomy, gives immediate relief. [6] In our study, ERCP and papillotomy, as well as basket extraction, were done in 118 patients.…”

Section: Discussionmentioning

confidence: 99%

Comparative study on presentation of biliary ascariasis with dead and living worms

Alam

Mustafa

Rahman

et al. 2010

Saudi J Gastroenterol

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Background/Aim:Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA). The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms.Materials and Methods:We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests.Results:The age (mean ± SD) of the patients was 36.8 ± 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic (131; 94.9%); others were acute cholangitis (30; 21.7%), obstructive jaundice (19; 13.8%), choledocholithiasis (20; 14.5%), acute pancreatitis (10; 7.2%), acute cholecystitis (6; 4.3%), liver abscess (2; 1.4%), hepatolithiasis (3; 2.2%), stricture of common bile duct (2; 1.4%), pancreatic abscess (1; 0.7%) and cirrhosis of liver (1; 0.7%). Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms.Conclusion:Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms.

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Biliary ascariasis: Report of a complicated case and literature review

Cited by 36 publications

References 0 publications

Ascariasis of the pancreatic duct

Ascariasis of the pancreatic duct

Radio-pathological diagnosis of hepatobiliary ascariasis: A rare entity

Comparative study on presentation of biliary ascariasis with dead and living worms

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