Massive infestation by Ascaris lumbricoides of the biliary tract: report of a successfully treated case

Abstract

This is a report of a 25 years old black woman from the city of São Paulo, Brazil, who developed acute obstructive cholangitis of Ascaris lumbricoides with septicemia and multiple hepatic abscesses. The patient had sickle cell trait and normal delivery 3 months ago. Massive infestation of the biliary tract by Ascaris lumbricoides was diagnosed by abdominal ultrasonography and endoscopic retrograde cholangiography. Sixty worms were removed from the common bile duct and hepatic abscesses were drained by surgery. The infectious process was polymicrobial. The patient's recovery was complete after a long evolution with a wide spectrum antibiotic therapy. New surgeries were needed to remove residual worms in the biliary tract. The diagnostic methods, clinical-biochemical features and also the clinical and surgical management are presented. The biliary ascariasis pathophysiology is commented.

Evaluation, Diagnosis and Treatment of Ascariasis: An Updated Review

“…The adult worm lives in the lumen of small intestine (85% in jejunum [1,8], and 15% in ileum) and maintain its position by muscle tone. Ascaris takes most of its nutrients from the partially digested food in the intestine.…”

“…About 0.8 to 1.2 billion people around the world are infected with ascaris. It is more common in tropical and sub tropical countries around the world and most heavily affected population being in the sub Saharan Africa [1][2][3], Latin America, China and East Asia with poor sanitation, poor personal hygiene and places where defecation in open place is common practice.…”