Successful Management of Biliary Ascariasis in a High-Endemic Zone and Low-Resource Setting in Ethiopia

Abstract

Ascariasis lumbricoides is a roundworm that causes one of the most common soil-transmitted helminth infections worldwide. Ascariasis is typically found in the jejunum and transmitted through the intake of Ascaris lumbricoides eggs through food and water. Initially, ascariasis can cause pulmonary symptoms during the first 6–8 weeks of ingestion and can progress to serious complications of intestinal obstruction and hepatobiliary manifestations. Biliary ascariasis is a complication of ascariasis migration from the jejunum to the hepatobiliary tree and can present with a variety of symptoms ranging from biliary colic to more serious features such as acute cholangitis. Though the mortality rate is low, limited resources for management can make it challenging to manage.

Biliary Ascariasis in a Pediatric Patient in Lithuania: Case Report and Literature Review

“…However, A. lumbricoides may sometimes cause various life-threatening complications. One of these complications is biliary ascariasis, which is more common among adults and occurs due to the migration of the helminth from the jejunum to the duodenum and through the ampulla of Vater to the biliary tree [ 8 , 9 ].…”

“…Conjugated hyperbilirubinemia with elevated liver enzymes (ALT, AST, GGT, and ALP) in laboratory tests indicates the obstructive cause of jaundice. However, a significant elevation in ALP does not occur in all patients [ 9 , 15 ]. Our patient experienced recurrent episodes of abdominal pain in the right upper quadrant, vomiting, and even jaundice during the last episode.…”

“…Research demonstrates that the majority (90 percent) of children with biliary ascariasis respond to antihelminthic treatment within 3–5 days, but some patients do require surgical intervention [ 6 ]. During ongoing investigations, patients are advised to undergo conservative treatment, consisting of intravenous fluids, antispasmodics, and a course of antihelminthic drugs [ 9 ]. Pyrantel pamoate, mebendazole, albendazole, and levamisole are effective antihelminthic drugs [ 7 , 21 , 22 ].…”