Non-western patterns of biliary stones and the role of ascariasis.

Abstract

Biliary calculi of a non-Western pattern were detected in 15 patients on real-time sonography performed over a 3-year period in a center serving a predominantly "Cape colored" (mixed race) population in South Africa. In two patients definite calculi were detected only in the common bile duct or gallbladder, but there was strong imaging and clinical evidence that the calculi were secondary to ascariasis. Twelve patients had intrahepatic calculi, predominantly left-sided, and evidence of past or present ascariasis. In at least five of the 12, biliary ascariasis was found at sonography or surgery. These fourteen patients reported recurrent, acute attacks of pain and cholangitis over a period of years. The symptoms were often difficult to distinguish clinically from those of uncomplicated intestinal or biliary ascariasis. The 15th patient had no evidence of ascariasis. Intrahepatic calculi were evenly distributed throughout both lobes and were clinically silent. Only one of the 13 patients with definite intrahepatic calculi had evidence of gallbladder calculi.

Endoscopic Diagnosis and Extraction of Biliary Ascaris: A Case Report

“…On the other hand, worms can mimic stones, as in this case. 6 In this patient, formation of stones in the gallbladder and common bile duct may be secondary to ascaris, as the patient may have had ascaris infection prior to the initial ultrasound showing gallstones 4 years ago. There is supportive evidence that ascaris is the cause for biliary stones, and the stones related to ascaris are thought to form in the hepatic ducts and not the gallbladder.…”

Biliary ascariasis in the etiology of recurrent pyogenic cholangitis in an endemic area

“…Ascaris lumbricoides and Clonorchis sinensis formed the nidus of the stones in 38% and 19% patients of RPC respectively in a study from Hong Kong [17]. In one study from South Africa on the role of ascariasis in non-western pattern of biliary stones, Ascaris lumbricoides was delineated in the biliary tree in 14 of the 15 patients [9]. However, many authors have casted doubt on such an association and believe that RPC and biliary parasites are common in the regions of world with low socioeconomic status and that their co-existence in the same patient may be related to their high prevalence without any cause and effect relationship.…”

“…The disease has also been reported from Indonesia, Japan, Singapore, Malaysia, South Africa and Chinese Immigrants in Canada [2][3][4][5][6][7][8][9]. In India (Kashmir), RPC constitutes 12.5% of all patients with biliary disease [10].…”

Image Diagnosis: Worm-Induced Biliary Obstruction

“…4 Biliary helminthiasis can present as biliary obstruction, pyogenic cholangitis, acute pancreatitis, liver cysts, and abscesses. 1,3,5 Patients typically have abdominal pain and may have jaundice or fever.…”

“…4 Biliary helminthiasis can present as biliary obstruction, pyogenic cholangitis, acute pancreatitis, liver cysts, and abscesses. 1,3,5 Patients typically have abdominal pain and may have jaundice or fever.2,4 Diagnosis is made by imaging (ultrasound or magnetic retrograde cholangiopancreatography), with antigen serum tests, or by direct visualization during ERCP. Computed tomography scans tend to only demonstrate biliary dilation, and are therefore less helpful in securing the diagnosis.…”