Common Bile Duct Obstruction due to Ascariasis

Abstract

Ascaris Lumbricoides (also known as roundworm), affects approximately one billion individuals across the globe and is considered the most prevalent helminthic infection. Although asymptomatic in majority of the population, these nematodes have the potential to present with intestinal obstruction and perforation. Biliary ascariasis leading to Common Bile Duct (CBD) obstruction is an uncommon manifestation. Abdominal ultrasound is the non-invasive investigation of choice with a high degree of sensitivity and specificity. Pyogenic cholangitis, liver abscess formation and pancreatitis are potentially life-threatening complications of untreated Hepatobiliary Ascariasis (HBA) hence early diagnosis and appropriate intervention is essential. Surgical intervention in combination with appropriate anthelmintic medications is often required to treat complex HBA. We present an interesting case of complex HBA and review of literature.

Biliary Ascariasis in a Pediatric Patient in Lithuania: Case Report and Literature Review

“…Throughout the migration of adult A. lumbricoides into the bile duct, the excretions of these parasites induce irritation, resulting in biliary colic, spasms of the sphincter of Oddi, and partial or complete biliary obstruction. In cases of co-infection, this progression may lead to such complications as cholangitis, cholecystitis, and inflammation of the pancreas [ 12 , 13 , 14 ]. Biliary ascariasis can manifest as abdominal pain, located in the right upper quadrant and lasting for several days, nausea and/or vomiting, general malaise, jaundice, and hepatomegaly [ 2 , 6 ].…”

“…We observed eosinophilia and a high concentration of IgE in the peripheral blood of our patient. Eosinophilia is often observed in the complete blood count, which usually reaches levels of 5–12 percent and sometimes as high as 30–50 percent in cases of bile duct ascariasis [ 14 ]. Eosinophilia usually occurs once the larvae migrate through the lungs, and it can also persist when adult worms relocate to the intestines, or when complications develop.…”

“…The diagnosis of ascariasis is confirmed after the detection of A. lumbricoides eggs in the stool. However, stool tests may often be negative [ 14 ]. In our case, the stool test was positive, together with Ascaris lumbricoides IgG4 antibodies being detected in the blood of our patient.…”

Gallbladder Perforation with Choledochogastric Fistula Due to Ascaris Infestation, a Case Report

“…These elements contribute to higher infection rates in tropical nations like Ethiopia. 14 The route of transmission involves ingesting raw vegetables or water containing embryonated eggs. Since adults do not multiply in humans, the symptoms depend on the amount of worms present in the intestine.…”

“…Obstructive jaundice is occasionally caused by biliary ascariasis. 14 When there is a large parasite load in the intestine, wandering worms particularly cause gallbladder infestation. The size, sex, and age of the host are related factors.…”