Rare presentation of biliary ascariasis

Ascariasis is the most common helminthic infection in the world. We present a very rare manifestation of ascariasis in which the worms came out through the T-tube tract of a 36 years old patient who had undergone cholecystectomy with choledochohthotomy

Presentation and endoscopic management of biliary ascariasis.

Ascaris lumbricoides is a common parasite and the most serious and dramatic presentation is hepatobiliary and pancreatic ascariasis (HPA). Therefore, this study was planned prospectively to elucidate the clinical presentation of HPA and evaluate the efficacy and safety of endoscopic intervention. In this study we documented 77 consecutive patients with HPA from January 2000 to November 2005. All the patients had endoscopically proven HPA. A total of 77 patients were included in the study. The age ranged from 6 to 80 years, with the third decade most commonly (28.6%) affected. Females were 6 times more likely to be affected than males. The commonest presentation was biliary colic (97.4%); other presentations were acute cholangitis (15.6%), obstructive jaundice (9.1%), acute pancreatitis (6.5%), choledocholithiasis (6.5%), acute cholecystitis (6.5%) and liver abscess (2.6%). In this report 51 (66.2%) had living, 10 (13%) had dead and 16 (20.8%) had both living and dead worms. Choledocholithiasis was associated only with dead worms. From one to 23 worms were found in the biliary tree. In 94.8% of cases we had to remove the worm by wide papillotomy followed by basket extraction. We did not experience any major complications during or following the procedures. Three patients had recurrent HPA during the course of follow-up (1 to 12 months). The majority of patients with HPA presented with biliary colic. This should be kept in mind in the management of an acute abdomen, especially in tropical countries. Endoscopic extraction is a safe and effective procedure for the treatment of HPA.

Endoscopic removal of one live biliary Fasciola gigantica.

Biliary fascioliasis was diagnosed in a woman from Angthong province, who presented herself with anorexia, weight loss, and jaundice for one month. Intraoperative retrograded cholangiopancreatography revealed a filling defect considered as a stone and bile sludge. By the sphincterotomy and balloon-extraction technique, one live fluke was removed and identified as Fasciola gigantica. A single dose of praziquantel, 25 mg/kg of body weight/day, was given although the postoperative stool examination revealed no Fasciola spp. egg. The patient was doing well after the fluke removal. According to a previous review, in this country, Ayutthaya is the southernmost province for the distribution of fascioliasis.

Wandering ascaris coming out through the T-tube tract--a rare occurrence.

A case of ascariasis of the common bile duct in the postoperative period of cholecystectomy and choledocholithotomy with T-tube drainage is reported. The living adult wandering ascaris came out through the T-tube tract immediately after removal of the T-tube. No such previous report has been found in the available literature.

Biliary tract obstruction due to Fasciola hepatica managed by ERCP

Fascioliasis is a health problem in several countries including the Islamic Republic of Iran. In a review of the medical publications during 1990-2002, only 22 cases of biliary tract obstruction by fasciola hepatica have been reported. Herein, we are adding a new case of fasciola hepatica causing bile duct obstruction and presenting with intermittent colicky pain, eosinophilia and bile duct dilatation. This condition was diagnosed by endoscopic retrograde cholaogiopancreatography [ERCP] and was treated by extemporaneous papillotomy. This case report confirms that in endemic areas, fascioliasis should be included in the list of the differential diagnosis for colicky abdominal pain, eosinophilia and bile duct dilatation. The condition could be concurrently diagnosed and treated by ERCP

Biliary ascariasis.

Biliary ascariasis is a less frequent, but important complication of ascaris infestation, because it may cause biliary colic, pyogenic cholangitis, and septicemia. Early diagnosis and treatment is important to prevent these complications. We present here a five-year-old girl with biliary ascariasis, whose main complaint was abdominal pain. After giving piperazin salt, multiple ascaris worms were seen in the stool within 10 days. She is at the follow-up without any complication.

Hepatobiliary and pancreatic ascariasis.

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Asia and Latin America. Of 4 million people infected in the United States, a large percentage are immigrants from developing countries. Ascaris-related clinical disease is restricted to subjects with heavy worm load, and an estimated 1.2 to 2 million such cases, with 20,000 deaths, occur in endemic areas per year. More often, recurring moderate infections cause stunting of linear growth, cause reduced cognitive function, and contribute to existing malnutrition in children in endemic areas. HPA is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in adult women and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, and hepatic abscess. RPC causing hepatic duct calculi is possibly an aftermath of recurrent biliary invasion in such areas. Ultrasonography can detect worms in the biliary tract and pancreas and is a useful noninvasive technique for diagnosis and follow-up of such patients. ERCP can help diagnose biliary and pancreatic ascariasis, including ascaris in the duodenum. Also, ERCP can be used to extract worms from the biliary and pancreatic ducts when indicated. Pyrantel pamoate, mebendazole, albendazole and levamisole are effective drugs and can be used for mass therapy to control ascariasis in endemic areas.

Ascariasis en vías biliares: presentación de dos casos / Bile duct ascariasis: two cases

Se presentan dos casos de ascariasis en vías biliares atendidos en el Hospital General Regional Núm. 36, Centro Médico Nacional "Manuel Avila Camacho", Instituto Mexicano del Seguro Social, Puebla, entre 1996 y 1997: mujeres de 43 y 28 años de edad que ingresaron con cuadro doloroso abdominal sugestivo de cólico biliar, y fueron atendidas médicamente. Egresaron por mejoría y reingresaron por dolor, una a los 20 días y otra al día siguiente. Los estudios preoperatorios fueron normales, en un caso la imagen ultrasonográfica correspondió a un áscaris en el colédoco, pero el diagnóstico no fue confirmado. Ambas pacientes fueron intervenidas, y la colangiografía transoperatoria demostró áscaris en vías biliares. La evolución posoperatoria fue satisfactoria en ambos casos. Se revisa la literatura médica, y se sugieren los métodos para el diagnóstico y tratamiento de esta patología

Parasitic disease of the liver and biliary tree

Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. biliary tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliaiy tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobilialy parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography [ERCP] is safe and effective in diagnosis and management of biliary tree parasites

Biliary ascariasis associated with periampullary carcinoma.

A 65 year old man presented with obstructive jaundice, biliary colics and recurrent cholangitis. Sonography revealed dilated intrahepatic biliary radicles and common bile duct. Bile duct also showed linear parallel intraluminal structures suggesting biliary ascariasis. The lower end of common bile duct and pancreatic region showed a mass which proved to be a coexistent periampullary carcinoma.

Ascaridiasis biliar en el niño: diagnóstico por ultrasonografía / Biliary ascaridiasis in children: ultrasonic diagnosis

La ascariasis es una de las principales parasitosis del hombre, muy común en países tropicales que tienen deficientes niveles de higiene afectando predominantemente al niño. Durante el ciclo de vida del Ascaris lumbricoides y bajo la influencia de varios factores los vermes adultos pueden migrar hacia la ampolla de Vater y penetrar en la vía biliar produciendo diferentes grados de obstrucción. La ecosonografía es un procedimiento rápido, simple, seguro y no invasivo para el diagnóstico del verme a dicho nivel. Presentamos en este trabajo una revisión de las características clínicas y ultrasonográficas de la ascaridiasis biliar en 5 niños diagnósticados con esta metodología en nuestra institución durante los últimos nueve años