Causa rara de distensión abdominal aguda: apertura del conducto pancreático en un quiste hidatídico / A rare cause of acute abdominal distention: opening of the pancreatic duct into hydatic cyst

Introducción. El quiste hidatídico, causado por Echinococcus granulosus, se observa mayormente en el hígado y los pulmones, aunque raramente también puede localizarse en cualquier órgano o tejido blando. En este artículo se presenta el caso de un paciente con quiste hidatídico pancreático con apertura del conducto pancreático en el quiste. A propósito de un caso: Se atendió en nuestra clínica a un niño de 10 años de edad con distensión abdominal significativa y dolor en el epigastrio de 10 días de evolución. La concentración de amilasa sérica era de 3709 U/l y la inhibición de la hemaglutinación para hidatidosis era de 1/160. En la tomografía computarizada de abdomen se observaron dos lesiones separadas y ascitis, un quiste hidatídico de tipo CE2 en la región de la cola del páncreas y un quiste hidatídico de tipo CE1 en el lóbulo izquierdo del hígado. Se realizó el drenaje percutáneo del quiste ubicado en la cola del páncreas y se inició tratamiento con albendazol. Se retiró la sonda de drenaje, y desde ese momento se ha realizado el seguimiento del paciente sin que se observen complicaciones.

Introduction. Hydatid cyst, which is caused by Echinococcus granulosus, is mostly seen in the liver and lungs although it may also rarely be found in any organ or soft tissue. This study presents an interesting case of pancreatic hydatid cyst in which the pancreatic duct opened into this cyst. Case report. A 10-year-old boy presented to our clinic with significant abdominal distension and pain in the epigastric region which had started 10 days previously. Serum amylase level was 3709 U/L and hemagglutination inhibition for hydatid disease was 1/160. At abdominal computed tomography, two separate lesions and ascites were determined, a CE2 hydatid cyst in the region of the tail of the pancreas and a CE1 hydatid cyst in the left lobe of the liver. Percutaneous drainage was applied to the cyst in the pancreatic tail, and the patient was started on albendazole. The drainage catheter was removed, and the patient has since been followed-up on an outpatient basis with no complications.

A rare cause of acute abdominal distention: opening of the pancreatic duct into hydatic cyst. / Causa rara de distensión abdominal aguda: apertura del conducto pancreático en un quiste hidatídico.

INTRODUCTION: Hydatid cyst, which is caused by Echinococcus granulosus, is mostly seen in the liver and lungs although it may also rarely be found in any organ or soft tissue. This study presents an interesting case of pancreatic hydatid cyst in which the pancreatic duct opened into this cyst. CASE REPORT: A 10-year-old boy presented to our clinic with significant abdominal distension and pain in the epigastric region which had started 10 days previously. Serum amylase level was 3709 U/L and hemagglutination inhibition for hydatid disease was 1/160. At abdominal computed tomography, two separate lesions and ascites were determined, a CE2 hydatid cyst in the region of the tail of the pancreas and a CE1 hydatid cyst in the left lobe of the liver. Percutaneous drainage was applied to the cyst in the pancreatic tail, and the patient was started on albendazole. The drainage catheter was removed, and the patient has since been followed-up on an outpatient basis with no complications.

Ascariasis of the pancreatic duct.

Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.

A rare case of ascariasis in the gallbladder, choledochus and pancreatic duct.

Due to the anatomical characteristics of the biliary tract, Ascaris lumbricoides rarely settles in the gallbladder, which makes biliary ascariasis a rare clinical condition. Ultrasonography plays a significant and practical role in the diagnosis and follow-up of suspected cases of biliary ascariasis. The 15-year-old case presented herein had been complaining of abdominal pain and dyspepsia for three months, and the clinical and laboratory findings for the patient indicated acute abdomen. Abdominal ultrasonography showed worms consistent with Ascaris inside a normal-sized gallbladder, dilated choledochus and the pancreatic duct. We started antiparasitic treatment in the patient, with cholangitis and pancreatitis diagnoses. Post-treatment follow-up ultrasonography showed a normal gallbladder, choledochus and pancreatic duct.

Ultrasound appearances of intra- and extrahepatic biliary ascariasis.

BACKGROUND: To determine the range of ultrasonographic (US) appearances of Ascaris lumbricoides roundworms in the biliary system, their distribution in the intra- and extrahepatic parts of the system, and associated features. METHODS: All cases of biliary ascariasis during a 10-year period were reviewed. There were 42 cases in which diagnosis was based on established US criteria, and 2 cases diagnosed surgically in which US had been negative. These 44 cases occurred in 36 patients. RESULTS: In the US-diagnosed cases, worms were present in intrahepatic ducts in 32 cases, in the main duct in 37, and in the gallbladder in eight. In six cases, the liver was lifted off the main portal vein by a bundle of worms obliterating the lumen of the main bile duct. Worms packing and dilating intrahepatic ducts produced pseudotumorous appearances in the liver in four cases and bundlelike appearances in three. Worms were also seen in the pancreatic duct in two cases. Stones in intrahepatic ducts were present in 12 patients. CONCLUSION: Biliary ascariasis should be searched for inside and outside the liver. The appearances of bundles and boluses are different from those of single worms. Intra- and extrahepatic biliary stones may be present.

Pancreatic-biliary ascariasis: experience of 300 cases.

BACKGROUND: Infestation with Ascaris lumbricoides is seen worldwide. Recently, there has been much interest in the pancreatic-biliary complications of Ascaris infection. In this study, we present our experience of 300 patients seen in a tertiary referral center. MATERIALS AND METHODS: Case charts of patients seen in the Department of Gastroenterology, University of Damascus, Syria, were analyzed, retrospectively, over a 5-yr period (September of 1988 to August of 1993). During this period, 1666 endoscopic retrograde cholangiopancreatographic studies were performed and pancreatic-biliary ascariasis was diagnosed in 300 patients (18%). RESULTS: The most common presenting symptom was abdominal pain, seen in 98% of patients (294 patients). Complications observed were ascending cholangitis (48 patients; 16%), acute pancreatitis (13 patients; 4.3%), and obstructive jaundice (4 patients; 1.3%). History of worm emesis was present in 25% of patients (76 patients). Most patients (240 patients; 80%) had previously undergone a cholecystectomy or an endoscopic sphincterotomy (232 patients; 77%). Worms were successfully extracted endoscopically in all except two patients, and there were no procedure-related complications. CONCLUSIONS: In endemic countries, ascariasis should be suspected in patients with pancreatic-biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Endoscopic management results in rapid resolution of symptoms and prevents development of complications.

[The taxonomic status of cestodes with an unusual localization from Antarctic seals]. / O sistematicheskom statuse tsestod s neobychnoi lokalizatsiei ot antarkticheskikh tiulenei.

The great structural diversity in the cestodes Glandicephalus antarticus (Baird, 1853) from the stomach and intestine of the Ross Seal and G. perfoliatus (Railliet et Henry, 1912) from the bile-pancreatic duct of the Weddel Seal was recovered. These two cestodes are moved out of the family Diphyllobothriidae Luhe, 1910 and considered as the new family Glandocephalidae fam. n. within the superfamily Diphyllobothrioidea. Redescriptions of both species, and some indices of invasion rate are provided.

Cryptosporidiosis of liver and pancreas in rhesus monkeys with experimental SIV infection.

Following an experimental SIV infection, 11 rhesus monkeys were evaluated to determine the presence of opportunistic infections. Five animals had severe alterations of the hepatobiliary tree, three of which were associated with the presence of numerous Cryptosporidium spp. Subacute to chronic inflammatory changes were observed in the pancreatic ducts of four animals, one without histologic evidence of parasites. In one animal, the inflamed ducts were associated with a chronic interstitial pancreatitis. The rate of Cryptosporidium infection together with hepatic and pancreatic involvement (36%) supports the hypothesis that systemic cryptosporidiosis is the result of a loss of protective mucosal immunity.

Ascaris-induced acute pancreatitis.

The incidence, clinical disease and outcome of acute pancreatitis caused by ascariasis in an endemic area of Kashmir, India, was studied prospectively. Ascariasis was an aetiological factor in 59 of 256 patients (23.0 per cent) with acute pancreatitis. Worms had invaded the bile duct in 51 patients, the pancreatic duct in four and both ducts in four. Pancreatitis was mild in 46 patients and severe in 13. Associated pyogenic cholangitis was present in eight. Acute complications occurred in 11 patients. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in all cases within 72 h of admission and delineated ascarides in the duodenum invading the ampullary orifice (44 patients), in the bile duct (55) and in the pancreatic duct (eight). At ERCP, worms were extracted from the ampullary orifice and removed via the mouth of 33 patients with intractable epigastric pain, leading to rapid relief of symptoms. The eight patients with pyogenic cholangitis underwent endoscopic nasobiliary drainage to decompress the bile ducts; worms were extracted from the bile duct of three of these patients using a Dormia basket. A total of 56 patients recovered from acute illness with a combination of conservative and endoscopic treatment; the other three required emergency surgery. At a mean(s.d.) follow-up of 19(7) months, ten patients showed symptomatic worm reinvasion of the biliary tree. The overall mortality rate was 3 per cent.

Pancreatic duct hyperplasia in a raccoon (Procyon lotor) caused by Atriotaenia procyonis.

A raccoon (Procyon lotor) live-trapped in Philadelphia, Pennsylvania was heavily infected with the tapeworm Atriotaenia procyonis. Histopathologic examination of the duodenum revealed this tapeworm attached to the mucosa; the mucosa was mildly hyperplastic without a significant inflammatory infiltrate. This tapeworm was seen also within the proximal pancreatic duct and histopathologic lesions associated with its presence consisted of marked hyperplasia of mucosal cells, causing the formation of an extensive papillary projection into the duct lumen. Inflammatory cellular reaction was minimal, consisting primarily of lymphocytes, and was seen in the mucosa and submucosa of the duct. The presence of A. procyonis in the pancreas of this raccoon is considered to be an aberrant location for this parasite and has not been reported previously.

Eurytrema procyonis in a raccoon (Procyon lotor) from New York state--a first report.

The digenean, Eurytrema procyonis, found in the pancreatic ducts of the raccoon (Procyon lotor), is reported for the first time from a juvenile female raccoon captured in July 1987, in New York State (USA). The presence of greater than 183 trematodes in the pancreatic ducts was an incidental finding at necropsy to an interstitial pneumonia which had caused emaciation, and for which the animal was euthanized. The pancreas, with the exception of the major pancreatic duct, was histologically normal. The duct, containing the parasites, was dilated and contained a diffuse subepithelial inflammatory infiltrate consisting primarily of eosinophils. Epithelial hyperplasia was present in tubulo-alveolar glands, and goblet cells were prominent.

Sonographic diagnosis and follow-up in a patient with pancreatic roundworms. A case report.

Ultrasonography showed roundworms (Ascaris lumbricoides) in the main pancreatic duct of a child with acute pancreatitis. This method was used to follow-up gradual reversion to normal during medical treatment.

Eurytrema procyonis in a New York fox.

A fox infected with canine distemper virus had multiple Eurytrema procyonis trematodes within the major pancreatic duct. The ductal epithelium was slightly hyperplastic and there was mild periductal fibrosis present. There was dilatation of the pancreatic duct containing the parasites. Numerous eosinophilic intracytoplasmic inclusions were present in the epithelium of multiple organs, including the pancreatic ducts.

Recurrent pancreatitis caused by a calcified ascaris in the duct of Wirsung.

A case report of recurrent pancreatitis in a 20-yr-old woman due to an impacted calcified Ascaris remnant within the duct of Wirsung is presented. Endoscopic retrograde cholangiography identified a filling defect in the proximal main pancreatic duct. Transampullary endoscopic retrieval failed to extract the calculus and operative intervention was required to remove the calcified worm remnant.

Human infection with the pancreas fluke, Eurytrema pancreaticum.

A 70-year-old Japanese woman with gastric cancer in Fukuoka Prefecture, Japan, was found at autopsy to have about 15 adult flukes, Eurytrema pancreaticum, in the dilated pancreatic ducts. The number of eosinophils in the blood was within normal limits. The two worms which were least damaged when removed from the gland were used for stained specimens, and another two were macerated to collect the eggs. The parasites (10 X 5, 11 X 7 mm in size) were broad, flattened, oval to fusiform. The suckers were large, the oral (2.1 X 2.0, 2.0 X 1.9 mm) being larger than the ventral (1.6 X 1.6, 1.4 X 1.5 mm). The eggs (47.06 +/- 3.88 X 30.35 +/- 2.74 microns) were embryonated in the uterus. These findings led to the identification of E. pancreaticum. This is the second documented case of eurytremiasis in man.