Ultrasonografía endoscópica para el diagnóstico de áscaris biliar: reporte de caso y revisión de la literatura / Endoscopic ultrasound for the diagnosis of biliary ascariasis: case report and literature review

Resumen Se presenta un caso de áscaris de la vía biliar (AB), cuya manifestación clínica fue ictericia obstructiva, acompañada de dolor abdominal causado por un cuadro de pancreatitis aguda. Inicialmente, se sospechó de etiología litiásica, por lo cual se realizaron estudios de imágenes diagnósticas y se evidenció la presencia de AB como hallazgo incidental, diagnosticado por ultrasonografía endoscópica biliopancreática (UEB), que fue confirmado y tratado mediante colangiopancreatografía retrógrada endoscópica (CPRE).

Abstract The following is a case of biliary ascariasis (BA), whose clinical presentation was obstructive jaundice, accompanied by abdominal pain due to acute pancreatitis. At first, clinical suspicion led to consider a stone etiology, for which diagnostic imaging studies were performed, evidencing BA as an incidental finding diagnosed by endoscopic biliopancreatic ultrasonography (EBU), which was confirmed and treated using endoscopic retrograde cholangiopancreatography (ERCP).

A Case of Biliary Ascariasis in Korea

Biliary ascariasis is still the leading cause of surgical complication of ascariasis, though its incidence has been dramatically reduced. Herein, we report a case of biliary ascariasis for the purpose of enhancing awareness of parasitic infections as a possible cause. A 72-year-old male visited the emergency room of Dankook University Hospital on 12 July 2015, complaining of right-upper-quadrant pain. By endoscopic retrograde cholangiopancreatography (ERCP), a tubular filling defect in the right hepatic duct was detected. The defect was endoscopically removed and diagnosed as an adult female of Ascaris lumbricoides worm, of 30 cm length. Upon removal of the worm, the pain subsided, and the patient was discharged without any complication. When treating cases of biliary colic, physicians should not neglect biliary ascariasis as the possible cause.

Biliary Ascariasis: Our Experience and Review of Literature.

Background/Aim: Ascariasis is endemic in the tropics especially amongst those living in poor sanitary conditions. Although most commonly it infests the small intestine, it can sometimes migrate to the biliary tract. We herein aimed to study the clinical manifestations, complications, diagnostic modalities and the most appropriate treatment modality for this condition. Materials and Methods: Fifteen cases of hepatobiliary ascariasis presenting over a period of 1.5 years were studied. All the patients were adults and presented to the emergency with acute biliary symptoms. Results: In this study, biliary ascariasis was found to be more common in middle aged females. The common presentations included upper abdominal pain and jaundice. Complications observed included acute pancreatitis and cholangitis. Ultrasonography could establish the diagnosis in 86.67% cases. Medical management could successfully treat 86.67% patients with ERCP being required in the remainder. Conclusion: In endemic countries, ascariasis should be considered as a differential diagnosis in patients presenting with acute biliary symptoms. Ultrasonography is a useful non invasive test to diagnose the condition and medical management remains a reasonable first line treatment option.

Biliary ascariasis - role of endoscopic intervention.

Aim: This study was undertaken to review the predisposing factors, presentation and management of patients diagnosed with biliary ascariasis while specifically emphasizing the role played by endoscopy. Methods: We performed a retrospective analysis of nine patients diagnosed and admitted with biliary ascariasis at our center. The diagnosis was based on ultrasound findings and confirmed by detection of round worms in the biliary tract or the descending duodenum. The clinical presentation and management were reviewed. Results: Five of the nine patients had prior biliary sphincter ablative/ bypass procedures for choledocholithiasis; including endoscopic sphincterotomy in four and lateral choledochoduodenostomy in one patient. All but one patient presented with acute onset pain abdomen radiating to the back. One patient presented with features of acute cholecystitis. Ultrasound detected the presence of round worms in all the patients. Endoscopic retrograde cholangio-pancreatogram confirmed presence of worm in the biliary tree. Endoscopic extraction of the worm from the biliary tree or duodenum was successfully undertaken in all the patients and provided prompt relief. One patient had recurrence of infection after eight months which was re-treated by endoscopic extraction. Antihelminthics were instituted in all patients. Conclusion: Biliary ascariasis, should be considered in the differential diagnosis of acute abdomen, particularly in patients who have undergone prior biliary sphincter ablation/ bypass procedures like sphincterotomy or choledochoduodenostomy. Ultrasonography is a reliable diagnostic modality. Endoscopic retrograde cholangiogram confirms the diagnosis and precedes endoscopic extraction of the worm. This offers prompt relief from symptoms.

MDCT Findings of Biliary Ascariasis: a Case Report

Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. The migration of Ascaris lumbricoides into the biliary tree is an uncommon but well-known complication of intestinal ascariasis and often results in biliary colic. A case of acute common bile duct obstruction caused by a roundworm in a 37-year-old woman, a North Korean defector, is reported. Ultrasonography showed no specific abnormal findings except acute cholecystitis and an intrahepatic biliary stone. However, the MDCT clearly demonstrated a linear filling defect in the common bile duct that led to the correct diagnosis. Biliary ascariasis should be considered in the differential diagnosis of upper abdominal pain of patients in populations at risk.

Sequential therapy for biliary ascariasis in 19 cases / 中华肝胆外科杂志

Objective To improve the curative effect of non-invasive therapy for biliary ascariasis to shorten the course of treatment and minimize the chance of invasive managements such as surgery and endoscopic therapy. Methods The sequential therapy was conducted as: intravenous injection of vitamin C → oral administration of acid drug → expel the worm in the biliary tract. Results For the 19 cases of biliary ascariasis, 15 responded to the conservative treatment after one course of treatment,2 responded to it after two courses, 1 after 3 courses and 1 did not. Conclusion Sequential therapy is effective, convenient and simple for biliary ascariasis and it can reduce the chance of invasive management.

An Unusual Presentation of Biliary Ascariasis

Ascariasis is one of the most common disease in human being worldwide. Ascariasis is 2nd to gall stone as a cause of biliary symptoms. The invasion of biliary tract by round worms during early post operative period is an infrequent but serious complication. We present 42 years old man operated for cholelithiasis with Choledocholthiasis on whom choledochotomy and T -Tube insertion was done. On 5th postoperative day Ascaris extruded peri-T-Tube and immediate T - Tube cholangiogram done that showed multiple filling defects in Common Bile Duct (CBD). Patient was managed with saline irrigation of CBD via T-Tube and anti-heliminthic was given. In view of its rarity and unusual presentation the case is being reported.

A Case of Acute Pancreatitis Caused by Ascaris Invasion of the Common Bile Duct / 대한소화기내시경학회지

Ascaris lumbricoides is the most common intestinal parasite in less-developed countries as well as in areas with poor sanitation. Highly motile mature worms may enter the ampulla of Vater and migrate to the bile or pancreatic ducts causing cholangitis, biliary stones, cholecystitis, pancreatitis and a liver abscess. The incidence of pancreatitis due to biliary ascariasis is relatively common in endemic areas, but only a few cases have been reported in Korea since 1990. A 68-year-old woman was admitted with a sudden onset of epigastric pain. She was diagnosed with acute pancreatits due to ascaris based on computed tomography, the ampulla-impacted state of the worm and an elevated serum amylase level. The patient recovered without complications after the ascaris had been extracted using grasp forceps during endoscopy. The patient also received antihelminthic therapy. We report this case with a review of the relevant literatures.

Study on clinical features, complication and treatment of biliary ascariasis in Hue central hospital

A study on 126 patients with biliary ascariasis (female/male: 4/1) in December 1997 in Hue Central Hospital has shown that the disease is initiated suddenly with severe pain in the right subcostal area and right chest (most common), vomiting, icterus, history of disease (80%). The common complications are bile duct infection, acute gallbladder infection, pancreatic reactions, acute pancreatitis, bile duct haemorrhage, bile duct abscess. Drugs: Pyrantil, antibiotics.

Contribution to highlight the biliary ascariasis in women with pregnancy who admitted Hue Central Hospital between 1/1998 to 4/1999

The study aims to identify the rate of pregnancy patients in childbearing-age female who have biliary ascariasis. Fetal abnormalities have not found. Complications as biliary infection, acute pancreatitis and pancreatic reactions were observed.

Investigating favorable factors and treatment responses in the patients with biliary ascariasis who admitted to Hue Central Hospital

Between 1990 to 1994, 217 patients were diagnosed with biliary ascariasis by ultrasonography. It was showed that biliary ascariasis is a pathological condition with excess incidence. Treatment in complicated or pregnant cases is difficult and costly. Some factors, especially female gender, pregnancy, and pH level of biliary fluid can influence favorably to the migration of ascarid. Ascarid infection density does not affect to the relapse frequency. Use helminthics early with single dose can provide the pain relief rapidly, reduce the rate of complication and avoid overuse the anti-spasmodics. The patients with history of biliary asariasis relapses should be followed-up and treated actively.

Treatment on biliary ascariasis (BA) and bilo-pancreatic ascaris (BPA) by endoscopy to removal of worms

The biliary ascariasis and bilo-pancreatic ascasis is a series of the biliary-liver diseases in Vietnam. Endoscopic worm removal is high effective. Study on 24 case with BA or BPA from 5/1997 to 6/1998 at Viet Duc Hospital, these patients were treated the worm removal by endoscope. Result shown that it is economic, effective new method. It required closely cooperation between clinical doctor and ultrasound, endoscope's doctor. Some factors related with biliary ascariasis like women, pregnancy, farmer, summer. When people have signs of BA and BPA, should endoscope to removal of worms.

Hepatobiliary ascariasis

This report, based on our experience of 197 clinical cases and 45 autopsies of biliary ascariasis, has led us to the following conclusions: 1. Hepatobiliary ascariasis is a disease that is quite common in Filipinos2. The condition may be clinically recognized by the characteristic symptomatology which has been described3. The diagnosis is frequently missed, especially in children, because of the frequent absence of abdominal rigidity in a patient with colicky abdominal pain4. Marked tenderness at the epigastrium, one to two fingerbreadths below the xiphoid process, is of great diagnostic significance in biliary ascariasis5. Confirmation of the diagnosis can frequently be made by the use of intravenous cholangiography6. Gastric hypoacidity or anacidity is present in the great majority of patients with biliary ascariasis7. Biliary ascariasis is frequently associated with gallstones in adults and is probably of etiologic importance in the genesis of gallstone in Filipinos8. Unrecognized hepatobiliary ascariasis in children is frequently fatal because of a high incidence of liver abscesses9. A program to eradicate or control ascariasis through education and public health measures will probably alter the incidence of biliary disease in Filipinos in the future. (Summary and Conclusions)

Some peculiarities of bile duct ascariasis in the pathology of biliary calculus in Vietnam

An investigation was conducted on 101 cases of biliary calculus. Results show a rate of 17.82% of bile duct ascariasis, from them 75% with ascaris found in the large duct and 75% died. 33% of cases had experienced a previous history of bile duct ascariasis. Bile culture had indicated a positive rate of 81.25% of aerobic bacteria and 4/6 of anaerobic.