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)

Percutaneous transhepatic cholangiography: a prospective study of the first 29 cases at UP-PGH Medical Center

A prospective study of the first 29 cases of percutaneous transphepatic cholangiogram at UP-PGH was evaluated as to its accuracy in detecting the causes of cholestasis, its complications and side effects. Definitive diagnosis was obtained by surgery (22), peritoneoscopy and liver biopsy (5). Percutaneous liver biopsy (1) and clinical follow-up (1). In 22 cases whose biliary trees were visualized, 19 were secondary to mechanical extrahepatic obstruction and 2 due to parenchymal liver disease. In 8 cases whose biliary trees were not visualized, 6 were secondary to parenchymal liver disease and 2 due to mechanical extrahepatic obstruction. Accuracy rate is 90% in visualized biliary trees and 75% in non-visualized biliary trees. Morbidity is minimal. (Summary)