Sonographic images of hepato-pancreatico-biliary and intestinal ascariasis: A pictorial review

Abstract

Despite advancement in the diagnosis and treatment of intestinal helminthiasis, ascariasis remains the most common cause of helminthic infections in the developing countries. Ultrasound offers a rapid, safe, and noninvasive approach to the diagnosis of intestinal ascariasis. Ultrasound is also the modality of choice for diagnosis of hepatobiliary ascariasis, which is relatively rare and is due to migration of intestinal worms through the papilla of Vater. We present an imaging spectrum of hepato-pancreatico-biliary and intestinal ascariasis.Main messages• Ascariasis refer to infestation by the round worm ascaris lumbricoides.• Ascaris eggs are excreted in faeces and are infective to humans.• Eggs hatch to larva, travel to the lungs and mature to adult worms.• Intestinal obstruction can be caused by multiple ascariasis forming bag of worms.

Unusual Cause for Massive Pediatric Lower Gastrointestinal Bleed with Atypical Postoperative Intestinal Sequelae

“…Plain radiographs may reveal a mass of worms described as "whirlpool pattern" in addition to air-fluid levels though this sign was not evident in our patient [15]. The roundworms may be detectable as tubulous, moving, echogenic structures on ultrasonography with anechoic fluid filled alimentary canal of the worm described as "the inner tube sign" [16]. Majority of children with subacute intestinal obstruction resolve spontaneously on conservative treat ment with bowel rest, antispasmodics, anthelminthics, and intravenous fluids [14].…”

Biliary Ascariasis with neither Cholangitis nor Obstructive Jaundice

“…However, in our case, the patient has only a vague abdominal pain [8]. The lack of experience in ultrasonographic specific signs [9] has to be considered but the diagnosis was made by MRCP.…”

Ascariasis imaging: pictorial essay

“…Complications are usually due to the mechanical organ obstruction caused by single adult worms (hepatobiliary and pancreatic obstructions). Although no reliable data exist, hepatobiliary ascariasis is far less common as compared to intestinal ascariasis alone [44,45].…”

“…The common bile duct and intrahepatic ducts can become very dilated; however, obstructive jaundice is rare [44]. Ascaris worms in the intrahepatic ducts are less common than in the common bile duct.…”