Imaging Findings in Complicated Hepato-biliary Ascariasis: A Case Report
Published: 2024-04-05
Page: 31-44
Issue: 2024 - Volume 7 [Issue 1]
Krishna Kumar. M. *
Department of Radio-Diagnosis. Trichy SRM Medical College Hospital & Research Centre, Irungalur, Trichy-621105, India.
Arun. R.
Department of Radio-Diagnosis. Trichy SRM Medical College Hospital & Research Centre, Irungalur, Trichy-621105, India.
Senthilnathan. V.
Department of Radio-Diagnosis. Trichy SRM Medical College Hospital & Research Centre, Irungalur, Trichy-621105, India.
Yashas Prasad. M.
Department of Radio-Diagnosis. Trichy SRM Medical College Hospital & Research Centre, Irungalur, Trichy-621105, India.
*Author to whom correspondence should be addressed.
Abstract
Aim: To review the clinical presentation and demonstrate imaging findings in complicated Hepatobiliary Ascariasis (HBA) and its management.
Presentation: A 45 years old male diabetic patient presented with the symptoms of fever, hiccoughs, abdominal bloating, nausea, and bilious vomiting lasting for 10 days with elevated bilirubin and Alkaline phosphatase levels.
Discussion: HBA arises from the migration of the intestinal parasite Ascaris lumbricoides from the duodenum into the biliary tree causing obstruction. HBA may present as, acute cholecystitis, biliary colic, pyogenic cholangitis, pancreatitis, obstructive jaundice, hepato-lithiasis and hepatic abscess. Significant morbidity and mortality are associated with HBA complications and hence early diagnosis and management is of utmost significance. Majority of cases are treated conservatively. Endoscopic withdrawal of Ascaris lumbricoides is feasible only upon the availability of expert endoscopy services and surgical removal if unavailable.
Conclusion: HBA though uncommon, it can direct to serious morbidity and mortality which necessitate early diagnosis of the disease. Clinical features of Ascariasis and laboratory tests are commonly non-specific. Multiple Imaging methods aids in morphological recognition of the roundworm, potential complications of HBA and treatment follow up.
Keywords: Biliary ascariasis, hepatobiliary ascariasis, oriental cholangio-hepatitis, recurrent pyogenic cholangitis, round worm
How to Cite
References
Macías-González GA, Santillán Arroyo A. Biliary ascariasis: An unusual cause of acute cholecystitis. Int Surg. J 2024;11: 480-2.
Nawin Kumar, Rajesh Nair, Anuja Sinha, Amit Kumar. Recurrent cholangitis secondary to Ascaris lumbricoides – A rare occurrence. Case Studies in Surgery. 2015;1(1).
Khuroo MS, Zargar SA. Biliary ascariasis. A common cause of biliary and pancreatic disease in an endemic area. Gastroenterology. 1985 Feb; 88(2):418-23.
PMID: 3965331.
Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary Ascariasis: Experience of 300 cases. Am J Gastroenterol. 1997 Dec; 92(12):2264-7.
PMID: 9399767.
Rahimi M, Mohamad IS, Yahya MM, Mohammad Azmi MAF, Voon Meng L. Biliary ascariasis: Extraction. Endoscopy. 2024 Dec; 56(S 01):E195-E196.
DOI: 10.1055/a-2258-8436.
Epub 2024 Feb 22.
PMID: 38388953;
PMCID: PMC10883872.
Cook GC Ascariasis and its prevention and control. Trans R Soc of Trop Moed Hyg. 1989;83(4):538.
Breno Lima dae Almeida, Daniel Vicente Silva, Mateus Santana do Rosário, aet al, Biliary ascariasis and severe bacterial outcomes: Report of three cases from a paediatric hospital in Brazil. International Journal of Infectious Diseases. 2020;95: 115-117.
ISSN: 1201-9712,
Available:https://doi.org/10.1016/j.ijid.2020.03.045
Lamberton PH, Jourdan PM. Human Ascariasis: Diagnostics Update. Curr Trop Moed Rep. 2015;2(4):189-200.
DOI: 10.1007/s40475-015-0064-9
Epub 2015 Oct 3.
PMID: 26550552;
PMCID: PMC4630244.
MY Wani, Bashir A Chechak, Farooq Reshi, Sanjay Pandita, Muddasar H Rather, Tariq A Sheikh, Ishfaq Ganie. Our experience of biliary ascariasis in children. J Indian Assoc Pediatr Surgery. 2006:11: 129-32.
Mukhopadhyay M. Biliary ascariasis in the Indian subcontinent: A study of 42 cases. Saudi J Gastroenterol. 2009 Apr; 15(2): 121-4.
DOI: 10.4103/1319-3767.48970
PMID: 19568577;
PMCID: PMC2702965.
Das AK. Hepatic and biliary ascariasis. J Glob Infect Dis. 2014 Apr; 6(2):65-72.
DOI: 10.4103/0974-777X.132042
PMID: 24926166;
PMCID: PMC4049042.
Krige J, Shaw J. Cholangitis and pancreatitis caused by biliary ascariasis. Clin Gastroenterol Hepatol. 2009 May; 7(5):A30.
DOI: 10.1016/j.cgh.2008.09.008
Epub 2008 Sep 27.
PMID: 19138758.
Cobo A, Hall RC, Torres E, Cuello CJ. Intrahepatic calculi. Arch Surg. 1964 Dec; 89:936-41.
DOI:10.1001/archsurg.1964.01320060004002
PMID: 14208465.
Leung JW, Chung SC. Endoscopic management of biliary ascariasis. Gastrointest Endosc. 1988 Jul-Aug; 34(4): 318-20.
DOI: 10.1016/s0016-5107(88)71364-4
PMID: 3410242.
Harris HW, Kumwenda ZL, Sheen-Chen SM, Shah A, Schecter WP. Recurrent pyogenic cholangitis. Am J Surg. 1998 Jul;176(1):34-7.
DOI: 10.1016/s0002-9610(98)00095-6
PMID: 9683129.
Lam SK, Wong KP, Chan PK, Ngan H, Ong GB. Recurrent pyogenic cholangitis: A study by endoscopic retrograde cholangiography. Gastroenterology. 1978 Jun; 74(6):1196-1203.
PMID: 648809.
Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet. 1990 Jun 23; 335(8704): 1503-6.
DOI: 10.1016/0140-6736(90)93037-p
PMID: 1972440.
Khuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic Ascariasis. World J Gastroenterol. 2016 Sep 7; 22(33):7507-17.
DOI: 10.3748/wjg. v22 .i33.7507
PMID: 27672273;
PMCID: PMC5011666.
Khuroo MS, Zargar SA, Mahajan R, Bhat RL, Javid G. Sonographic appearances in biliary ascariasis. Gastroenterology. 1987 Aug; 93(2):267-72.
DOI: 10.1016/0016-5085(87)91013-4. PMID: 3297910
Lynser D, Handique A, Daniala C, Phukan P, Marbaniang E. Sonographic images of hepato-pancreatico-biliary and intestinal ascariasis: A pictorial review. Insights Imaging. 2015 Dec; 6(6):641-6.
DOI: 10.1007/s13244-015-0428-7
Epub 2015 Sep 16.
PMID: 26373649;
PMCID: PMC4656235.
Mani S, Merchant H, Sachdev R, Rananavare R, Cunha N. Sonographic evaluation of biliary ascariasis. Australas Radiol. 1997 May; 41(2):204-6.
DOI: 10.1111/j.1440-1673.1997.tb00718.x
PMID: 9153828.
Ng KK, Wong HF, Kong MS, Chiu LC, Tan CF, Wan YL. Biliary ascariasis: CT, MR cholangio-pancreatography, and navigator endoscopic appearance--Report of a case of acute biliary obstruction. Abdom Imaging. 1999 Sep-Oct; 24(5):470-2.
DOI: 10.1007/s002619900542
PMID: 10475930.
Danaci M, Belet U, Polat V, Incesu L. MR imaging features of biliary ascariasis. AJR Am J Roentgenol. 1999 Aug; 173(2):503.
DOI: 10.2214/ajr.173.2.10430167
PMID: 10430167.
Wasadikar PP, Kulkarni AB. Intestinal obstruction due to ascariasis. British Journal of Surgery. March 1997;84(3): 410–412.
Available:https://doi.org/10.1046/j.1365-2168.1997.02506.x
Ferreyra NP, Cerri GG. Ascariasis of the alimentary tract, liver, pancreas and biliary system: Its diagnosis by ultrasonography. Hepatogastroenterology. 1998 Jul-Aug; 45(22):932-7.
PMID: 9755984.
Cremin BJ, Fisher RM. Biliary ascariasis in children. AJR Am J Roentgenol. 1976 Feb; 126(2):352-7.
DOI: 10.2214/ajr.126.2.352
PMID: 175704.
Chen YS, Den BX, Huang BI, Xu LZ. Endoscopic diagnosis and management of Ascaris-induced acute pancreatitis. Endoscopy. 1986 Jul; 18(4):127-8. PMID: 3732180.
Khuroo MS, Zargar SA, Yattoo GN, Koul P, Khan BA, Dar MY, Alai MS. Ascaris-induced acute pancreatitis. Br J Surg. 1992 Dec; 79(12):1335-8.
DOI: 10.1002/bjs.1800791231
PMID: 1486433.
Smith JW. Anthelmintic drugs. In: Clark WG, Brater DC, Johnson AR, editors. Goth’s Medical Pharmacology. 13th ed. Mosby Year Book: St. Louis; 1992: 699-703.
Beckingham IJ, Cullis SN, Krige JE, Bornman PC, Terblanche J. Management of hepatobiliary and pancreatic Ascaris infestation in adults after failed medical treatment. Br J Surg. 1998 Jul; 85(7): 907-10.
DOI: 10.1046/j.1365-2168.1998.00764.x
PMID: 9692561.
Alam S, Mustafa G, Ahmad N, Khan M. Presentation and endoscopic management of biliary ascariasis. Southeast Asian J Trop Moed Public Health. 2007 Jul; 38(4):631-5.
PMID: 17882999.
D A Lloyd. Massive hepatobiliary ascariasis in childhood. British Journal of Surgery. July 1981;68(7):468–473.
Available:https://doi.org/10.1002/bjs.1800680709
Das AK. Hepatic and biliary ascariasis. J Glob Infect Dis. 2014 Apr; 6(2):65-72.
DOI: 10.4103/0974-777X.132042
PMID: 24926166;
PMCID: PMC4049042.
Alam S, Mustafa G, Rahman S, Kabir SA, Rashid HO, Khan M. Comparative study on presentation of biliary ascariasis with dead and living worms. Saudi J Gastroenterol. 2010 Jul-Sep; 16(3):203-6.
DOI: 10.4103/1319-3767.65200.
PMID: 20616417;
PMCID:PMC3003205.