Successful Conservative Management of Uncomplicated Gallbladder Ascariasis

Abstract

Ascariasis is one of the common diseases in human beings worldwide. Most cases are asymptomatic. However, the high parasitic load can present with organ-specific symptoms due to the migration of worms to various regions of the body such as the lungs, nasal cavity, oral cavity, and biliary system, and sometimes with surgical emergencies like intestinal and biliary tree obstruction. Treatment modalities depend on the presentation and the complication associated with it. Uncomplicated cases can be initially managed conservatively and followed up subsequently. However, most cases of biliary ascariasis may require surgical intervention or endoscopic management due to failed management or complications. We report a case of a young male with gallbladder ascariasis diagnosed with ultrasonography and successfully treated with a single dose of albendazole 400 mg. Follow-up ultrasonography was done to evaluate the management.

An Overview of Ascariasis Involvement in Gallbladder Disease: A Systematic Review of Case Reports

“…The AW shows up in imaging studies as a curved/linear moving echogenic structure with an anechoic central line and characteristic movement of these long echogenic structures within the bile duct. The AW localized within the gallbladder can present as an echogenic-filing defect appearing as a bull's eye [1,5,[9][10][11][13][14][15]. Figure 4 shows the AW in the gallbladder presenting with a bull's eye appearance.…”

“…Educating patients on anthelmintic eradication and hygienic practices is integral to preventing ascariasis [10,13,15,19]. Figure 7 summarizes the recommended approach to management.…”

“…The anatomical structure of the cystic duct makes it tedious for the AW to migrate to the gallbladder when there is a low count of worm infestation. A high volume load of AWs in the intestine can influence movement through the narrow cystic duct to the gallbladder through the ampulla orifice from the duodenum [ 10 , 11 , 13 , 18 ]. Worms tend to migrate when there is a load of 1000 AW or more from the intestine [ 13 ].…”

“…US is preferable to MRCP and ERCP because of easy accessibility, cost, and safety. It has high sensitivity (85.7%) and is non-invasive [ 10 , 18 ]. US is the gold standard for GA because it is specific and safe.…”

“…If there is a whipworm co-infection, treatment of choice should be mebendazole. For patients requiring a water-soluble alternative with tube feedings, AW is treated with levamisole and pyrantel pamoate [ 5 , 10 , 14 ].…”