Comparative study on presentation of biliary ascariasis with dead and living worms

Abstract

Background/Aim:Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA). The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms.Materials and Methods:We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests.Results:The age (mean ± SD) of the patients was 36.8 ± 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic (131; 94.9%); others were acute cholangitis (30; 21.7%), obstructive jaundice (19; 13.8%), choledocholithiasis (20; 14.5%), acute pancreatitis (10; 7.2%), acute cholecystitis (6; 4.3%), liver abscess (2; 1.4%), hepatolithiasis (3; 2.2%), stricture of common bile duct (2; 1.4%), pancreatic abscess (1; 0.7%) and cirrhosis of liver (1; 0.7%). Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms.Conclusion:Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms.

Four Major Factors Contributing to Intrahepatic Stones

“…For example, the pathogenic mechanisms of Ascaris may include Ascaris excreting various types of polypeptides producing allergic manifestations which lead to biliary walls damage and bile duct inflammatory. The dead worms and the eggs form the nucleus of stones, and the worms block bile duct causing cholestasis and bacterial infection [8]. Besides, these worms have high glucuronidase activity, which deconjugates bilirubin and forms pigment stones.…”

Decreased Morbidity and Mortality from Intestinal Ascariasis: Experience of a Single Center

“…Intestinal obstruction may be partial or complete and treated conservatively or surgically. 1 Biliary and pancreatic ascariasis may be associated with biliary colic, acute cholangitis , obstructive jaundice, choledocholithiasis, acute pancreatitis, acute cholecystitis, liver abscess , hepatolithiasis , stricture of common bile duct , pancreatic abscess and cirrhosis of liver 18 . Biliary ascariasis with dead worms is more dangerous than that with living worms 18 and endoscopic or surgical intervention may be required repeatedly in those with dead worms 18 .…”

Ascariasis and Coexistant Stone in Common Bile Duct in Post Cholecystectomy Post Choledocholithotomy Woman: A Case Report

“…14 Intervention is required in a small proportion of patients under the following circumstances. 16 1. Those critically ill with pyogenic cholangitis or unresolving cholecystitis.…”