Direct cholangiographic features and therapeutic methods of biliary ascariasis.

Abstract

The diagnosis of biliary ascariasis was chiefly made by intravenous cholangiograpahy before operation in the past. At that time, differential diagnosis of biliary ascariasis from other biliary disorders was difficult because the direct cholangiography was not established yet. Fourteen patients of biliary ascariasis had been diagnosed by direct cholangiography including PTC 3 cases, ERCP 10 cases and post-operative cholangiography 1 case. According to the location of worms, it could be classified into (i) intrahepatic group 5 cases (35.7%) and (ii) extrahepatic group 9 cases (64.3%). Sex distribution disclosed male to female of 3 to 11. Combination of ductal stones and obstructive jaundice occurred in 60% (3 cases) and 80% (4 cases) respectively in the intrahepatic group. In fact, the clinical manifestation is much severer in the intrahepatic group than in the extrahepatic group. Stenosis of hepatic duct was observed in 4 of 5 cases in the intrahepatic group but none in the extrahepatic group. Surgery is undertaken while the possibility of cholecystocholangitis or other complications are manifested with persisting high fever and jaundice. If the biliary ascaris still presented 2 weeks after cholangiographic study, surgery would also be considered.