3 T MR cholangiopancreatography appearances of biliary ascariasis

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides , in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

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“…Of late, MRI and MRCP can help in diagnosis of HPA and may replace ERCP if therapeutic procedure is not envisaged (Figure 11)[52-54]. …”

Section: Hepatobiliary and Pancreatic Ascariasismentioning

confidence: 99%

Hepatobiliary and pancreatic ascariasis

Khuroo

Rather

Khuroo

et al. 2016

WJG

105

129

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“…MR cholangiogram may show intraductal worms as a linear low-intensity filling defect in the bile ducts. The “three-line sign” appears to be a characteristic sign of biliary ascariasis on 3D magnetic resonance cholangiopancreatography (MRCP) [ 5 ]. ERCP is highly sensitive in detecting parasites in the biliary and pancreatic ducts.…”

Section: Discussionmentioning

confidence: 99%

Gallbladder Mucus Plug Mimicking Ascaris Worm: An Ambiguous Cause of Biliary Colic

Termos

Alali

Alkabbani

et al. 2017

Case Reports in Surgery

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Biliary colic is a visceral pain caused by attempts of the gallbladder or bile duct to overcome the obstruction in the cystic duct or ampulla of Vater. Obstruction can be due to different etiologies such as stone, mass, worm, and rarely by mucus plug. We report the case of a 31-year-old gentleman who presented with recurrent biliary colic and weight loss. Work-up showed linear calcifications in the gallbladder extending to the common bile duct suggesting hepatobiliary ascariasis. Further investigations including stool analysis, upper endoscopy, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP) did not support our provisional diagnosis. Laparoscopic cholecystectomy was performed. Histopathological finding was grossly ambiguous; a rope-like mucus plug resembling ascaris worm was noted. The patient's condition improved instantly after the procedure. To our knowledge, we are reporting the first case in the English literature describing this unique entity of symptomatic gallbladder disease to increase awareness and improve its management.

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“…However, abdominal ultrasound has limitations, especially in cases of location at the lower bile duct. In these cases, abdominal CT or nuclear magnetic resonance imaging (MRI) ………….. may be indicated [18,20]. Abdominal CT, usually performed especially in cases of persistent diagnostic doubt, is less sensitive than ultrasound for Ascaris detection, but allows a better assessment of the severity of pancreatitis, angiocholitis, liver damage and elimination of another associated lesion [9,15,18].…”

Section: Paraclinic Aspectsmentioning

confidence: 99%

Ascaridiose des voies biliaires: à propos de 2 cas au service de chirurgie générale du centre hospital-universitaire Aristide Le Dantec et revue de la littérature

DIÉMÉ¹,

Thiam²,

Guèye³

et al. 2019

Batna J Med Sci

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Ascaris lumbricoïdes infection is a cosmopolitan helminthiasis that is endemic in tropical countries of the globe. Often asymptomatic, it is sometimes revealed by complications that make it serious. Biliary ascariasis is one of them. We report 2 cases of ascariasis of the common bile duct in the General Surgery Department of Hospital Le Dantec of Dakar (Senegal). These were two patients with hepatic colic and acute angiocholitis in whom the diagnosis was made by ultrasound. Treatment was surgical in both cases. Through these 2 cases we review the diagnostic and therapeutic aspects of this disease rarely described in our regions, which are however ascaridian endemic zones.

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3 T MR cholangiopancreatography appearances of biliary ascariasis

Cited by 15 publications

References 7 publications

Hepatobiliary and pancreatic ascariasis

Hepatobiliary and pancreatic ascariasis

Gallbladder Mucus Plug Mimicking Ascaris Worm: An Ambiguous Cause of Biliary Colic

Ascaridiose des voies biliaires: à propos de 2 cas au service de chirurgie générale du centre hospital-universitaire Aristide Le Dantec et revue de la littérature

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