Abstract
A 65-year-old male was admitted to the hospital because of right hypochondralgia. He was pointed out of severe jaundice. The abdominal ultrasonography revealed tubular hyperechoic regions in the choledochus and the gallbladder and heterogenous hyperechoic regions in the liver. After an endoscopic papillosphincterotomy, worms were removed by basket forceps under a diagnosis of hepatobiliary ascariasis. Choledocholithotomy, cholecystectomy, insertion of a T-tube and incision of hepatic abscess were performed on November 5th in 1992. In the diagnosis of hepatobiliary ascariasis, abdominal ultrasonography which reveales characteristic pictures such as tubular hyperechoic region without acoustic shadows, “spaghetii sign” and “bulls' eye sign”, and endoscopic retrograde pancreatocholangiography are useful. Conservative treatments include administration of anti-helminthic agents and endoscopic removal of the warms. If endoscopic decompression of the biliary tree is not possible or massive hepatobiliary ascariasis is recognized, surgery is indicated. Multiple hepatic abscess due to ascarids, however, often presents difficulty in the treatment even by surgical intervention.
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