Ascaridiasis hepatobiliar en una adulta joven / Hepatobiliary ascaridiasis in a young adult woman

Se presenta el caso clínico de una paciente de 27 años de edad, con antecedentes de colecistectomía convencional desde hacía 10 meses por aparente colecistitis, quien acudió al Hospital Luis Vernaza de Guayaquil, Ecuador, por presentar ictericia y dolor abdominal. Teniendo en cuenta los hallazgos clínicos, de laboratorio e imagenológicos se le diagnosticó sepsis de foco abdominal, colangitis y coledocolitiasis. Durante la intervención quirúrgica se observó la presencia de 2 Ascaris lumbricoides y cálculo de colesterol en la vía biliar, por lo que se le realizó una derivación bilioentérica. Después de algunas complicaciones como insuficiencia respiratoria y descompensación hemodinámica, la paciente egresó de la institución a los 25 días de operada, con seguimiento por consulta externa durante 2 meses.

The case report of a 27 years patient is presented, with history of conventional cholecystectomy for 10 months due to apparent cholecystitis who went to Luis Vernaza Hospital in Guayaquil, Ecuador, presenting jaundice and abdominal pain. Taking into account the clinical, laboratory and imaging findings a sepsis of abdominal focus, cholangitis and choledocolithiasis was diagnosed. During the surgical intervention the presence of 2 Ascaris lumbricoides and cholesterol calculi in the bile duct was observed, reason why a bilioenteric bypass was carried out. After some complications such as breathing failure and hemodynamic upset, the patient was discharged from the institution 25 days after the surgery, with follow up in outpatient clinics during 2 months.

[ULTRASOUND DIAGNOSIS OF PARASITIC INVASION OF THE GALLBLADDER].

Migration of ascaris from the lumen of the small intestine to the biliary system was previously thought to be very rare pathology and the diagnosis had not be without specific examination methods. At the present time widespread active ultrasonic technologies in the emergency surgical service can became more accessible to show worm in a gall bladder and ducts. The paper presents two cases of gallbladder ascariasis, identified by ultrasound.

[Ascaridiasis as an incidental finding after intraoperative cholangiography during a laparoscopic cholecystectomy]. / Ascaridiasis als Zufallsbefund nach intraoperativer Cholangiographie im Rahmen einer laparoskopischen Cholezystektomie.

We report a case of biliary ascariasis which was detected fortuitously during a routine intraoperative cholangiography following laparoscopic cholecystectomy. The diagnosis was confirmed by the finding of worm eggs in the faeces. We were able to discharge the patient on the 15th postoperative day after antihelmintic treatment.

[Hepatobiliary ascaridiasis in childhood: echographic diagnosis]. / L'ascaridiasi epatobiliare nell'infanzia: diagnostica ecografica.

Ascaris lumbricoides infestation in the liver and biliary tract causes various clinical manifestations due to the migration of larvae and adult organisms. Parasites in the bile ducts cause obstruction and such complications as cholecystitis, cholangitis and liver abscesses. We report the US findings of biliary ascaridiasis as observed in a series of 13 children over a 3-year period. The patients (6 females and 7 males) presented hepatosplenomegaly, abdominal distension, right subcostal pain; 3 of 13 exhibited subicteric features and fever. The US features of Ascaris lumbricoides infestation are: hyperechoic linear images due to parasites within the dilated bile ducts, target images; mobile hyperechoic linear images within the gallbladder; intrahepatic abscesses with different features and sizes. Microscopic sections of hepatic tissue show inflammatory infiltration around the Ascaris eggs. Emergency surgery is sometimes to be performed. The value of US, as we assessed it, has been already stressed by other authors.

Hepatic ascaridiasis.

Adult Ascaris, which are usually found in the intestine, can enter the ampulla of Vater if the sphincter of Oddi is not efficient. This situation seems common in children; in adults it occurs after endoscopic or surgical sphincterotomy. The worms can then migrate up into the intrahepatic bile ducts and provoke biliary stasis which may become infected and complicated by abscesses. It is inside such abscesses that we may find fragments of adult Ascaris. In the 4 cases reported in the literature during the last 20 years, we note in particular that the clinical signs vary considerably, according to the age of the patient. In children, the parasitic infestation is often massive and the clinical features are extremely serious, namely shock and acute abdominal pain, which lead to a laparotomy being done. In adults, the clinical feature is that of a biliary infection. Here we describe a fifth case of hepatic ascaridiasis which differs from the others in that the diagnosis was established by ERCP and CT scan and that treatment was medical.