Laparoscopic Management of Biliary Ascariasis: A Case Report and Review of Literature

Abstract

Acute pancreatitis due to Ascaris lumbricoides is a known etiology but very rare in Qatar. The diagnosis can be difficult because of thelow index of suspicion. We report a case of 25-year-old Philippine patient living in Qatar who developed an acute pancreatitis due toAscaris lumbricoides and was diagnosed initially as biliary pancreatitis. We proceeded with laparoscopic cholecystectomy and intraoperativecholangiogram which revealed Ascaris in the common bile duct. Transcystic extraction of a living worm from the common bileduct was done. This is the first case report of acute pancreatitis due to Ascaris lumbricoides which had laparoscopic transcysticextraction of a living worm from the common bile duct.Background: Ascaris lumbricoides as etiology to acute pancreatitis has never been described in Qatar whereas in developing tropicaland subtropical areas, Ascaris lumbricoides is found in human gastrointestinal tract with greater prevalence.1 Although the infection canbe asymptomatic, in some cases the adult parasite can invade the biliary or pancreatic ducts and cause obstruction with developmentof cholecystitis, cholangitis, and pancreatitis and hepatic abscesses.2 We report a case of a patient with biliary ascariasis induced acutepancreatitis.Conclusion: We recommend the use of this laparoscopic approach for treatment of such uncommon pathology, if surgical interventionis needed. The differential diagnosis of pancreatitis should be expanded to include ascariasis in patients who come from population atrisk. Knowledge of clinical symptoms, complications, and diagnostic and therapeutic options are of paramount importance for all healthprofessionals.