Successful Elimination of Gallbladder Ascariasis by Conservative Therapy, Followed by Cholecystectomy due to Developing Cholecystitis

Abstract

Background Ascaris lumbricoides is the most common parasitic infection in human. The worm is usually located in the small intestine, but may invade into the pancreatic or biliary tree, but rarely into gallbladder because of the anatomic features of the cystic duct. Case Presentation We report a case of gallbladder ascariasis that was diagnosed incidentally in a 70-year-old man, with negative ova and parasite test and no eosinophilia. We also compared echography and computerizied tomograph as diagnostic tools for gallbladder ascariasis. The patient was managed conservatively, but he underwent cholecyctectomy later because of developing cholecystitis. Conclusion Depending on this case, we suggest cholecyctectomy as an initial management of gallbladder ascariasis.

Gallbladder ascariasis: a case report and review of literature

“…But for a worm in Common bile duct (CBD), Endoscopic retrograde cholangiopancreatography (ERCP) should be preferred as it serves both diagnostic and therapeutic purposes. 1,7 Worms on USG usually appear as echogenic structures, usually linear, with a central anechoic line with erratic movements if alive.8 Our patient had the features same as that of dead worm and MRI endorsed the findings. Different medical treatments have been tried before the surgical management of the condition i.e., Metronidazole, mebendazole and piperazine citrate.…”

“…6 Other complications include biliary colic, gallstones, pancreatitis, obstructive jaundice, sepsis and liver abscess. 1 Patients with worms in gallbladder present with nonspecific symptoms as mild abdominal pain and low-grade fever. Blood work and stool examination is also unremarkable most of the times; as was in our case; so only modality conclusive of diagnosis is imaging.…”

“…Ascaris lumbricoides is the most common parasite infecting human populations around the globe. 1 Jejunum is the most common abode for the worm, from where they can travel anywhere along the hepatobiliary tree upto gallbladder which is quite uncommon due to narrow and tortuous nature of cystic duct. 2 Despite that it accounts for 2.1% of the hepatobiliary ascariasis.…”

An Overview of Ascariasis Involvement in Gallbladder Disease: A Systematic Review of Case Reports

“…The AW shows up in imaging studies as a curved/linear moving echogenic structure with an anechoic central line and characteristic movement of these long echogenic structures within the bile duct. The AW localized within the gallbladder can present as an echogenic-filing defect appearing as a bull's eye [1,5,[9][10][11][13][14][15]. Figure 4 shows the AW in the gallbladder presenting with a bull's eye appearance.…”

“…It is rare for the AW to invade the gall bladder because the biliary tract is fragile, narrow, and tortuous; only 2.1% of hepatobiliary ascariasis comes from the gallbladder [ 1 , 9 ]. The anatomical structure of the cystic duct makes it tedious for the AW to migrate to the gallbladder when there is a low count of worm infestation.…”