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

Abstract

Ascaris lumbricoides is the most widespread cause of helminthic infestations in developing countries. It is more prevalent and its course more serious in children than in adults (1). The parasite most commonly settles in the mid-section of the ileum and jejunum in the intestines. Intestinal infection is generally asymptomatic. However, serious complications may occur, such as ascending cholangitis, acute acalculous cholecystitis, obstructive jaundice, pancreatitis, liver abscesses, and septicemia, with the settlement of the parasite in the biliary tract ascending upwards from the intestines (2,3). Due to the narrow and tortuous structure of the biliary tract, it is rare for the parasite to invade the gallbladder or the pancreatic duct (1). This presentation evaluates the diagnosis and follow-up findings with ultrasonography (US) of a rare case of ascariasis settled in the gallbladder, choledochus and pancreatic duct, causing cholangitis and pancreatitis. CASE REPORTA 15-year-old female living in a rural area presented to our hospital with complaints of abdominal pain, nausea, vomiting, fever, anorexia, and weight loss. The patient had sensitivity in the right hypochondriac and epigastrium and hepatomegaly. Her laboratory examinations revealed: leukocytosis (18000/μl), significant increases in aspartate aminotransferase (AST) 55 (<37) IU/L, alanine aminotransferase (ALT) 107 (<40) IU/L and amylase 340 (<83) IU/L. They also showed slight increases in alkaline phosphatase 94 (32-92)

An alien in the gallbladder. A rare case of biliary ascariasis in an Italian emergency department

“…Hepatobiliary ascariasis is more common now than in the past, maybe because of the more frequent use of ultrasonography and endoscopic diagnostic procedures in the clinical practice. 5,9,11 Sonographic findings included a non-shadowing, long, echogenic structure in the form of a coil, an echogenic strip with central anechoic tube, an echogenic structure extending across the gallbladder giving it a septate appearance, and characteristic erratic, non-directional, zigzag movements of these echogenic struc- Computed tomographic scanning 10,12 and magnetic resonance imaging (MRI) 19 may also be used to identify worm(s) in the liver or bile ducts but this is not usually necessary. Ultrasonography promptly shows worm's movement in the biliary tree and this is an important advantage of US over CT and MRI.…”

“…Several reports exist about the successful medical treatment of gallbladder ascariasis. 5,8,10,[12][13][14]18,19 Sometimes surgery 4,6,8,10,16 or the endoscopic procedures 7,8,10 such as endoscopic retrograde cholangiopancreatographic examination are required. Albendazole and mebendazole are first-line agents for the treatment of ascariasis.…”

“…Ascaris lumbricoides, which usually resides in the small bowel, may migrate into aberrant sites, overall into the bile duct, causing biliary colic and obstructive jaundice. 2 Ascaris lumbricoides adult worm, typically 15-30 cm long and 3-6 mm thick, 2 rarely settles in the gallbladder [3][4][5] due to the anatomical characteristics of the cystic duct which is narrow and tortuous. Anomalous origin of the cystic duct directly from the papilla of Vater 6 and previous sphinterotomy 7 facilitate worm invasion into the gallbladder.…”

Ascariasis of the pancreatic duct

“…However, conservative treatment can be used alone without further invasion procedures 17 18. First choice drugs used for eradication of helminths are albendazole and mebendazole, and, alternatively, levamisole 14–18.…”

Ascaris lumbricoides’in Neden Olduğu Süpüratif Kolanjit: Fatal Seyirli Olgu Sunumu

“…Tubular or serpiginous structures with echogenic walls in the dilated biliary ducts are sonographic findings suggestive of biliary ascariasis 7,8 . Computerized tomography, magnetic resonance imaging (MRI) and ERCP are other diagnostic methods that can be used 9,10 .…”