Biliary ascariasis – A vicious cycle

Biliary ascariasis is a rare disease in a non-endemic area. However, it is one of the possible etiological factors for retarded growth as well as malnutrition in children. It may cause intestinal obstruction, appendicitis, biliary obstruction, liver abscess, hepatolithiasis, and pancreatitis in adults. Herein, we report a patient with ascending cholangitis secondary to biliary ascariasis who was successfully managed with Endoscopic Retrograde Cholangio Pancreaticography.

Massive biliary ascariasis: an unusual cause of acute cholangitis

Acute cholangitis is a condition of bacterial infection following hepatobiliary tract obstruction, which signifies poor prognosis unless adequately drained. The most common cause of bile duct obstruction is choledocholithiasis, in contrast to parasitic infestation, a rare entity causing acute cholangitis nowadays. Therefore, we reported the case of a 68-year-old Thai man who presented with acute fever, intense right upper quadrant abdominal pain and jaundice for 2 days. His medical history was normal except for the history of intermittent biliary colic for a year. Endoscopic retrograde cholangiography was performed and demonstrated multiple, creamy-coloured roundworms coming out from the ampulla of Vater as well as a tubular filling defect in dilated common bile duct from cholangiography. He was diagnosed with acute cholangitis by biliary ascariasis and underwent endoscopic parasitic removal, which subsequently improved symptoms.

Mechanical jaundice caused by common bile duct obstruction due to hepato-biliary ascariasis

The paper presents a case of successful surgical treatment of a patient with common bile duct ascariasis, which caused obstructive jaundice. Modern methods of examining a patient with obstructive jaundice did not allow to make the right diagnosis of the common bile duct ascariasis before surgical intervention. The rarity of this pathology arouses interest in this material.

Surgical manifestations and management of gastrointestinal and hepato-pancreato-biliary ascariasis: an observational study

Background: Ascaris lumbricoides is the largest intestinal nematode parasite of humans. This study describes different presentations and management patterns of gastrointestinal and hepato-pancreato-biliary ascariasis presenting to a tertiary centre of North-eastern India.Methods: This was a prospective observational study aimed to study the presentations and management patterns of Ascaris related surgical diseases including intestinal obstruction, pancreatitis and cholangitis in a tertiary centre of Northeast India. All consenting cases of gastrointestinal and hepato-pancreato- biliary ascariasis admitted in our hospital were included.Results: Ninty patients with Ascaris sequeale were included, which included biliary ascariasis without cholangitis: 36, pancreatitis: 30, cholangitis: 18 and sub-acute intestinal obstruction: 6. Ultrasound was the most useful diagnostic investigation followed by stool examination and endoscopy. Hepato-pancreato-biliary ascariasis was managed conservatively and the progress monitored with sonography. The surgical management choledocho-duodenostomy was done for three patients having biliary ascariasis with unresolving obstructive jaundice and recurrent cholangitis on conservative management and 6 patients underwent therapeutic endoscopic worm removal. There were no deaths. No patient needed ICU care.Conclusions: Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Hepato-pancreato-biliary ascariasis can be managed conservatively for majority of the patients.