Intrahepatic Duct Stones Harboring Ascariasis Ova

Abstract

Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication—hepatolithiasis.A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.

Hepato biliary pancreatic ascariasis: a rare case report

“…The ova of ascariasis have albuminated membrane that is highly cohesive which facilitates precipitation of calcium carbonate stones on the surface and the worm has high glucoronidase that deconjugates the bilirubin and forms pigment stones by precipitation with calcium. 5 The initial management for the ascarial infection will be medical especially for mild symptoms and those with intestinal variants of infection. But those with extraintestinal the efficacy of the antihelminthics is less due to poor enterohepatic circulation and they are not effective within the biliary tract.…”

Liver and Bile Duct Infections

“…248,463,464 Hepatolithiasis in association with ascariasis has also been described. 465 The worms can also penetrate liver tissue (visceral larva migrans), perforate the Glisson capsule, and exit into the subdiaphragmatic space. 248 Adult worms or ova may be present in tissue sections.…”

Comparison of the clinical effects of dual-modality endoscopy and traditional laparotomy for the treatment of intra- and extrahepatic bile duct stones

“…Bile duct stones (BDSs) are calculi that occur in the hepatobiliary system and are etiologically related to cholestasis, bile duct infection, stenosis or obstruction, and the presence of foreign bodies in the bile duct[ 1 - 3 ]. Occurring in the digestive system, BDSs often do not heal spontaneously; moreover, intrahepatic BDSs can easily migrate to the common bile duct and become extrahepatic BDSs, which may progress to cirrhosis and even liver cancer[ 4 ].…”