Hepatobiliary and pancreatic ascariasis

Abstract

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides , in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

Ascariasis imaging: pictorial essay

“…the echogenic strips inside the ducts. Other signs include gallbladder and cystic duct distension, gallbladder wall edema, sludge inside the gallbladder, and multiple liver abscesses [32]. Retained worm fragments can serve as a nidus for biliary stones.…”

“…They may also present later as intrahepatic duct calculi due to recurrent biliary obstruction [46]. Ultrasound allows visualization of single worms, bundles of worms, or pseudotumor-like appearance [32,33,47]. The worms can be extracted endoscopically [48].…”

“…Ascarides are localized in the intrahepatic ducts in most of these patients. Pus from the abscess often reveals ova of Ascaris and/or fragments of dead ascarides [32]. On ultrasound, hepatic ascariasis might contain single or multiple long linear or curved echogenic structures without acoustic shadowing.…”

Safra Kesesi Askariazisi: Olgu Sunumu ve Literatürün Gözden Geçirilmesi

“…It has been reported that 25% of the global population is infected. 1 Ascaris eggs are usually transmitted to children while they are playing with soil. In adults, transmission may be through eating raw vegetables contaminated with sewage water.…”

An Uncommon Cause of Cholangitis and Cholecystitis

“…It is acquired through the ingestion of matured ova in contaminated water, raw vegetables, and food [1][2][3].…”