Pancreatic Ascariasis Research Articles

Hepato biliary pancreatic ascariasis: a rare case report

Ascariasis is an infection caused by Ascaris lumbricoides. Most of these infections are in the gastrointestinal tract. Its extraluminal infestations involving the liver, pancreas and biliary tract are rare and its complications are usually morbid. This aspect of extra intestinal manifestation is termed hepato biliary and pancreatic ascariasis. We report a 65 years old female with history of recurrent abdominal pain and on evaluation found to have Ascarial infection with complications involving liver, biliary and pancreas. She was optimized and taken up for surgery and she recovered well. The ascarial infections are generally seen in the paediatric populations and most of them are intestinal. Here we presented an adult with extraintestinal Ascariasis who had complications of hepatobiliary and pancreatic system which was managed successfully and she was presented for its rarity.

A Case of Fatal Disseminated Ascariasis: Clinico-Diagnostic Dilemma

Ascaris lumbricoides is the most common soil transmitted helminth in India. Hepatobiliary and Pancreatic Ascariasis (HPA) is relatively an uncommon complication. We present a case of fatal HPA with genitourinary involvement. Morbidity and mortality can be minimized by keeping in mind the importance of basic investigations which can lead to a definite diagnosis in such cases for instituting timely treatment.

Incidence of non biliary non alcoholic acute pancreatitis in a tertiary hospital

Background: Acute pancreatitis is an important cause of hospital admission with acute abdomen. It is responsible for significant morbidity and also mortality in patients.
 Objective: To determine the incidence of non-biliary nonalcoholic acute pancreatitis (Non A non B) and also to compare the incidence with alcoholic and biliary pancreatitis in the department of surgery of Chittagong Medical College Hospital, Bangladesh as well as with the developed countries
 Methods: This prospective study was carried on 75 patients of both sex having acute abdominal pain characteristic of acute pancreatitis and serum amylase >3 times normal, admitted in General Surgery wards in CMCH and supported by biochemical test during June 2008 to May 2010.
 Results: The mean (±SD) age was 36.1±15.4 years and 32.7±14.3 years in male and female group respectively (p>0.05) and maximum number was found in the age group of 20-30 years in both groups. Choledocolithiasis were 2(33.3%) and 7(21.9%) in male and female respectively evaluated by USG. Sludge in GB 1(16. 7%) in male and 7(21.9%) in female. Biliary ascariasis 3(50.0%) and 16(50.0%) in male and female respectively. Alcoholic was found 4(16.0%), Biliary 2(8.0%) and Non Alcoholic non Biliary 19(78.0%) in male patients. Biliary 32 (64.0%) and Non Alcoholic non Biliary 18(36.0%) in female patients. The difference was statistically significant (p<0.05). It was observed that the total patients were 75 among them Alcoholic was 4(5.3%), Biliary was 34(45.3%) and Non Alcoholic non Biliary was 37(49.3%) of study patients.
 Conclusion: Non-A non-B acute pancreatitis accounts for about a half - of all cases of acute pancreatitis and is significantly less frequent among female patients. Biliary pancreatitis was higher in female subjects. Bilio pancreatic ascariasis is 50.0% in both male and female subjects.
 Journal of Surgical Sciences (2017) Vol. 21 (2): 85-88

EUS of pancreatic ascariasis

Ascaris is a common cause of acute pancreatitis in developing countries. The mechanism of ascariasis induced acute pancreatitis include obstruction of papilla of Vater, invasion of common bile duct, or pancreatic duct (PD). PD ascariasis is a rare diagnosis. Endoscopic ultrasound is a highly accurate method to diagnose the aetiology of idiopathic acute pancreatitis with reference to biliary and pancreatic ascariasis. Treatment usually consist of endoscopic removal of worms with dormia basket or forceps on side viewing endoscopy. Ascaris induced pancreatitis is generally mild and worm extraction is associated with rapid relief of symptoms. We present a case of PD ascariasis diagnosed on endoscopic ultrasound.

Pancreatic duct ascariasis: Case series

Background and Objectives:Although uncommon in the West, Ascaris lumbricoides is a common cause of acute pancreatitis in developing countries. The mechanism of acute pancreatitis in ascariasis may be due to obstruction of papilla of Vater, invasion of common bile duct (CBD), or pancreatic duct (PD). The invasion of PD occurs rarely owing to its smaller caliber. Ultrasonography (USG) is an effective tool for the diagnosis of biliary and pancreatic ascariasis; however, the diagnosis may be false negative in up to 30% of cases. Pancreatic ascariasis is a rare entity. We present our retrospective data of last 10 years of 15 cases of pancreatic ascariasis.Methods:During a study period of 10 years, 15 cases of pancreatic ascariasis were diagnosed by USG/endoscopic ultrasonography (EUS). EUS was performed with a linear or radial echoendoscope. Thirteen patients presented with symptoms of acute pancreatitis. Out of 13 patients, nine presented with first episode of idiopathic pancreatitis while four presented with idiopathic recurrent acute pancreatitis. One patient had biliary colic and one patient presented with acute cholangitis. Twelve patients had mild pancreatitis while only one had moderate pancreatitis. Only two cases were diagnosed with USG while 13 patients were diagnosed with EUS. Out of 15 patients, 14 underwent side viewing endoscopy with removal of live single/multiple worms with rat tooth forceps/biopsy forceps/dormia basket in 13 patients. Two patients were managed conservatively with repeat USG showing absence of ascariasis. There were no complications.Results:Two patients had associated bile duct ascariasis. EUS features were single or multiple linear hyperechoic structure without acoustic shadowing in the PD or CBD or with central hypoechoic tube, representing alimentary canal of the worm and movements of worms inside the duct. Live roundworms were removed from CBD and PD without undertaking sphincterotomy. In endemic areas, sphincterotomy facilitates the risk of migration of worms into the CBD.Conclusion:Ascariasis-induced acute pancreatitis is mild and EUS is the investigation of choice. The recurrence is rare and treatment is side viewing endoscopy with removal of worms. Although USG is quite sensitive for diagnosing biliary and pancreatic ascariasis, its sensitivity significantly falls when the worm is thin, in the PD, or the CBD is non-dilated. EUS should be used early in the workup of idiopathic acute pancreatitis after the first episode.

Pancreatic ascariasis as an unusual cause of recurrent pancreatitis: An endoscopic ultrasound diagnosis

Background:Ascaris lumbricoides infestation is endemic in tropical countries. Most infections are asymptomatic, but it can produce a wide spectrum of manifestations including hepatobiliary and pancreatic complications. Biliopancreatic ascariasis is rare outside the endemic regions.Case Report:We report a case of recurrent pancreatitis, symptomatic for the last 2 years, multiple hospitalizations, various imagings with ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography failed to establish the etiology, and endoscopic ultrasound revealed an adult A. lumbricoides worm inside the main pancreatic duct. The patient underwent endoscopic retrograde cholangiopancreatography with extraction of the dead worm; deworming was done with albendazole 400 mg, single dose. Patient is symptom-free for the last 1 year.Discussion and Conclusion:Biliary ascariasis is a common occurrence in endemic regions and is causally associated with biliary colic, acute cholangitis, acute pancreatitis and its complications, recurrent pyogenic cholangitis, acute cholecystitis, and liver abscess. Secondary to smaller duct diameter, migration of A. lumbricoides into the pancreatic duct is uncommon. Even in highly endemic areas such as Kashmir, India, pancreatic ascariasis was rare and represented only 1.4% of all hepatobiliopancreatic ascariasis. Endoscopy ultrasound is a useful modality in diagnosis and management of patients with pancreatic ascariasis.

Pancreatic duct ascariasis: Case series

Background and Objectives:Ascaris lumbricoides is a common cause of acute pancreatitis in the developing countries. Ultrasonography (USG) is a useful tool for the diagnosis; however, the diagnosis may be false negative in up to 30% of cases.Materials and Methods:During a study period of 10 years, 15 cases of pancreatic ascariasis were diagnosed by USG/endoscopic ultrasound (EUS). Thirteen patients presented with symptoms of acute pancreatitis. Of 13 patients, nine presented with first episode of idiopathic pancreatitis while four presented with idiopathic recurrent acute pancreatitis. One patient had biliary colic and one patient presented with acute cholangitis. Twelve patients had mild pancreatitis while only one had moderate pancreatitis. Only two cases were diagnosed with USG while 13 patients were diagnosed with EUS. The patients underwent side viewing endoscopy/endoscopic retrograde cholangiopancreatography under the same sedation after EUS if EUS revealed biliary/pancreatic ascariasis. Of 15 patients, 14 underwent side viewing endoscopy with removal of live single/multiple worms with rat tooth forceps/Dormia basket in 13 patients. Two patients were managed conservatively with repeat USG showing the absence of ascariasis. There were no complications.Results:EUS features were single or multiple linear hyperechoic structure without acoustic shadowing in the pancreas divisum with central anechoic tube representing alimentary canal of the worm. Live roundworms were removed from papilla without undertaking sphincterotomy. In endemic areas, sphincterotomy facilitates the risk of migration of worms into the common bile duct.Conclusions:Ascariasis-induced acute pancreatitis is mild and EUS is the investigation of choice. The recurrence is rare and treatment is side viewing endoscopy with removal of worms.

Bile Duct and Pancreatic Duct Ascariasis - a Case Report

Bile Duct and Pancreatic Duct Ascariasis - a Case Report

Hepatobiliary and pancreatic ascariasis

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

Hepatobiliary and pancreatic ascariasis-sonographic pictorial essay on four pediatric cases with acute biliary colic.

Hepatobiliary and pancreatic ascariasis occur due to migration of the round worm ascaris lumbricoides through the bile duct orifice finally reaching the common bile duct, main pancreatic duct, intrahepatic ducts or gallbladder. These resulted in acute epigastric and right hypochondriac region colicky pain. Ultrasound is the investigation of choice in hepatobiliary ascariasis. We present here sonographic images on four pediatric patients with acute biliary colic.

Pancreatic ascariasis with periampullary carcinoma

Ascarias lumbricoides infestation is endemic in tropical countries. Most infections are asymptomatic, but it can produce a wide spectrum of manifestations including hepatobiliary and pancreatic complications. There are reports of association of biliary ascariasis with bilary malignancies in the past, but same is not known for pancreatic ascariasis. We report a case of association of periampullary malignancy with pancreatic ascariasis.

Ascaris lumbricoides as etiologic factor for pancreas inflammatory tumor

A 58 years old male consulted to his practitioner due to long evolution and continuous abdominal pain with non constantdiarrhea. His medical history includes chronic ischemic cardiopathy, atrial flutter, hypertension, bilateral hip prosthesis. Acolonoscopy was performed finding no abnormalities. The scanner showed an infiltrative mesenteric mass of 7 x 14 cmwith undefined margins which contacted with pancreatic cephalic portion and uncinate process (Fig. 1). A MRI dismissedlocal and linfovascular infiltration. The study was completed with a FNA cytology guided by EUS being positive for neoplasticcells, suggesting pancreatic adenocarcinoma moderately differentiated. After this diagnosis cephalic pancreaticoduodenectomywas performed.Postoperative evolution was good with a pancreatic leak solved with medical measures. Further anatomical pathologyanalysis demonstrated pancreatic ascariasis with fibrocaseous nodules and abscess affecting cephalic pancreas and transversemesocolon (Fig. 2). There were no tumor cells founded in the surgical specimen. The patient was treated with albendazole400 mg.

Ascariasis pancreática que simula un tumor pancreático

Background and aim Ascaris lumbricoides infection in Spain is anecdotal and is usually associated with travel to areas with high endemicity such as India and South America. Biliopancreatic disease caused by this parasite is both rare and one of the most feared complications. There are few publications in the literature about pancreatic involvement in ascariasis. We describe a case of pancreatic ascariasis diagnosed after a pancreaticoduodenectomy was performed for a suspected pancreatic adenocarcinoma. Patient A 58-year-old man consulted for longstanding abdominal pain and diarrhea. Computed tomography and magnetic resonance scans, endoscopy, and e ndoscopic ultrasound-guided fine-needle cytology were performed. The pathological diagnosis was moderately differentiated adenocarcinoma of the pancreatic head. Results Cephalic pancreaticoduodenectomy was performed. The postoperative course was favorable. A pancreatic fistula type B (ISGPF classification) developed and was resolved with conservative treatment. Analysis of the surgical specimen revealed the presence of a pancreatic pseudotumor due to Ascaris lumbricoides. After these findings, treatment was completed with oral albendazole. Conclusions Pancreatic ascariasis in our environment is unusual, but should be included in the differential diagnosis of tumors and inflammatory processes of the pancreas.

Spontaneous air in the main pancreatic duct

A 34-year-old lady was referred to us after an episode of acute biliary pancreatitis which was diagnosed three months back, and resolved on conservative treatment. She again became symptomatic with abdominal discomfort after one month. There was no history of vomiting, dyspnea, jaundice, fever, weight loss or anorexia. Her laboratory parameters were: Hb 12 gm, leukocyte count 8600/cmm, S. amylase 350, bilirubin 1.2 mg, and alkaline phosphatase 428 IU/dL; serum protein and transaminase values were normal. CECT of the abdomen revealed air in the main pancreatic duct (PD) (Fig. 1); the duct was normal in caliber. CT also showed multiple fluid collections suggestive of pseudocyst, stone in gall bladder and dilated common bile duct (CBD). She underwent ERCP which showed large periampullary diverticula with normal CBD and normal PD without any extravasations of contrast from PD. She was kept on conservative management for the pancreatic pseudocyst. At six month follow-up, she was asymptomatic; follow-up ultrasound did not reveal air in pancreatic duct but showed the decrease in pseudocyst size to 2.5 cm. Air in the pancreas is frequently reported to be associated with an abscess or a pancreatic fistula but has also been demonstrated in normal pancreatic glands. It has been shown to occur with duodenal obstruction, biliary and pancreatic ascariasis with liver abscesses, pancreatic pseudocyst and acute or chronic pancreatic. 1-4 Our patient was a follow-up case of acute pancreatitis who had presented with pseudocyst and was found to have air in pancreatic duct. In the majority of cases reported in the literature, the air was visualized by US and only in three cases was the air seen at CT abdomen. In our case no air was detected in the biliary tree as had been reported in some of the previously described patients.

Isolated pancreatic duct ascariasis in a child

Isolated pancreatic duct ascariasis in a child

Management of hepatobiliary and pancreatic ascariasis in children of an endemic area

Ascariasis is the most common parasitic infestation in endemic areas and accounts for 50-60% of pediatric admissions in the surgical emergency department. Hepatobiliary and pancreatic ascariasis accounts for about 10% of such admissions. The present study was undertaken to evaluate the clinical features, investigations, and management of hepatobiliary and pancreatic ascariasis. The study was conducted in the endemic areas of Kashmir in northern India over a period of 3 years. During the study period (May 2001 to April 2004), 214 children with hepatobiliary and pancreatic ascariasis were admitted in the department. These children underwent complete clinical evaluation, investigation including ultrasound, and ERCP when required. Surgical intervention was done in patients who failed to settle with medical treatment. Ninety percent of our admissions were from rural areas and 86% of the children presented with pain in the right hypochondrium. Twenty-two percent of patients presented with cholangitis, whereas 39% of the children had mild icterus at presentation. Thirty-eight percent of the children had vomited worms during the episode of illness. Ultrasound was the diagnostic method of choice, which revealed the worms in the CBD in 80% of the patients, and in gall bladder in 16% of the children. Eight patients had worms in the main pancreatic duct while seven (4%) had multiple small liver abscesses. Serum alkaline phosphatase was raised in majority of children (80%). Twenty (9%) children were referred for ERCP. Medical treatment including endoscopic management was successful in 97% of the children. Seven (4%) children had to be operated upon due to complications of the disease. We conclude that the majority of the children with hepatobiliary and pancreatic ascariasis respond to conservative treatment, and surgical treatment is rarely needed.

Ascaridiose

Ascaris lumbricoides is a specific human parasitic disease. Ascariasis is the most frequent intestinal parasitic infestation. The geographical distribution is essentially in poor intertropicals countries where facilitating factors are climatic conditions and faecal peril. Hookworm live generally in jejunum. Morbidity and mortality are linked to intestinal obstruction or hepatobiliary and pancreatic ascariasis. Chronic infestation may be responsible to malnutrition in children when polyparasitism is frequent. Now medical treatment with benzimidazole antihelmintics is easy. Surgical treatment of complications is infrequently necessary. Struggle against poverty is principal factor influencing decreasing of ascariasis.

Biliopancreatic ascariasis: endoscopic approach.

From June 1985 to June 1999, 120 patients were diagnosed by means of panendoscopy, choledocoscopy, and endoscopic retrograde cholangiopancreatography as having biliary and pancreatic ascariasis. All duodenoscopic procedures were performed under fluoroscopic control. Endoscopic extraction was successful in 99 of 108 (92%) patients, some of whom had had previous endoscopic sphincterotomy. The endoscopic accessories used were a basket catheter, polypectomy snare, and balloon catheter. Because no significant complications were observed after this endoscopic treatment, we recommend endoscopic extractions for biliary ascariasis.

ASCARIASIS

Ascariasis is a helminthic infection of global distribution with more than 1.4 billion persons infected throughout the world. The majority of infections occur in the developing countries of Asia and Latin America. Of 4 million people infected in the United States, a large percentage are immigrants from developing countries. Ascaris-related clinical disease is restricted to subjects with heavy worm load, and an estimated 1.2 to 2 million such cases, with 20,000 deaths, occur in endemic areas per year. More often, recurring moderate infections cause stunting of linear growth, cause reduced cognitive function, and contribute to existing malnutrition in children in endemic areas. Ascaris infection is acquired by the ingestion of the embryonated eggs. The larvae, while passing through the pulmonary migration phase for maturation, cause ascaris pneumonia. Intestinal ascaris is usually detected as an incidental finding. Ascaris-induced intestinal obstruction is a frequent complication in children with heavy worm loads. It can be complicated by intussusception, perforation, and gangrene of the bowel. Acute appendicitis and appendicular perforation can occur as a result of worms entering the appendix. HPA is a frequent cause of biliary and pancreatic disease in endemic areas. It occurs in adult women and can cause biliary colic, acute cholecystitis, acute cholangitis, acute pancreatitis, and hepatic abscess. RPC causing hepatic duct calculi is possibly an aftermath of recurrent biliary invasion in such areas. Ultrasonography can detect worms in the biliary tract and pancreas and is a useful noninvasive technique for diagnosis and follow-up of such patients. ERCP can help diagnose biliary and pancreatic ascariasis, including ascaris in the duodenum. Also, ERCP can be used to extract worms from the biliary and pancreatic ducts when indicated. Pyrantel pomoate, mebendazole, albendazole, and levamisole are effective drugs and can be used for mass therapy to control ascariasis in endemic areas.

Worm extraction and biliary drainage in hepatobiliary and pancreatic ascariasis

From December 1989 to March 1992, 50 (32%) of 156 patients with hepatobiliary and pancreatic ascariasis underwent various endoscopic interventional procedures. Endoscopic intervention was performed when patients did not respond to energetic symptomatic treatment within the first few days of hospitalization (n = 45) or when worms had not moved out of the ducts into the duodenum at 3 weeks (n = 5). Worm extraction was successful in all 18 patients from the ampullary orifice and in 34 (89.5%) of 38 patients from the bile or pancreatic duct. In five patients with pyogenic cholangitis, endoscopic nasobiliary drainage was performed to decompress the bile ducts. After worm extraction/nasobiliary drainage, 41 (91%) of the 45 patients with biliary disease (n = 42) or acute pancreatitis (n = 3) had rapid relief of symptoms. Three patients developed complications related to endoscopy, including cholangitis (n = 2) and hypotension (n = 1).