Ascariasis as an Unexpected Cause of Acute Pancreatitis with Cholangitis: A Rare Case Report from Urban Area
Abstract
Context Ascaris lumbricoides is one of the most common parasitic infestations of human gastrointestinal tract. This parasitic infestation might be asymptomatic and only few studies on extraintestinal ascariasis have been reported. Ascending cholangitis and acute pancreatitis as a result of the Ascaris lumbricoides migrating into the biliary system and pancreatic duct were very rare complications. Here, we presented a case report of biliary ascariasis induced acute pancreatitis with cholangitis without imaging supported in a patient coming from urban area. Case report A 33-year-old woman lives in Bangkok, urban area of Thailand. She presented with severe epigastric pain for one day. Her diagnosis was Ascaris lumbricoides induced acute pancreatitis accompanied with ascending cholangitis. The investigation results showed no eosinophilia and no ascaris eggs in stool examination. The abdominal computed tomography showed slightly common bile duct dilatation. The parasite was found during an endoscopic retrograde cholangiopancreatography performed. The cholangiography revealed a roundworm in common bile duct. The parasite was successfully removed by using an extraction balloon catheter and a snare. Microbiological examination of the parasite revealed a 22 cm long adult form of Ascaris lumbricoides. Conclusion Ascaris lumbricoides is the uncommon cause of biliary obstruction with complications. It is also a possible cause even in the patients who live in urban areas. Endoscopic removal is the treatment of choice in addition to antihelminthic medications.
Image: An adult form of Ascaris lumbricoides after extraction from common bile duct.
Downloads
References
Khuroo MS. Ascariasis. Gastroenterology clinics of North America 1996; 25: 553-77.
Villamizar E. Ascaris lumbricoides infestation as a cause of intestinal obstruction in children: experience with 87 cases. Journal of pediatric surgery 1996; 31: 201-4. [PMID:8632280]
Misra SP, Dwivedi M. Clinical features and management of biliary ascariasis in a non-endemic area. Postgraduate medical journal 2000; 76: 29-32. [PMID:10622777]
Al-Qurashi A, Maklad KM, Al Abdulwahed O. Pancreatitis due to ascaris lumbricoides, a case report. J Egypt Soc Parasitol 2003; 33: 657-62. [PMID:14708843]
Madsen RB, Djurhuus H. Acute pancreatitis caused by Ascaris lumbricoides. Ugeskr Laeger 2000; 162: 3730-1. [PMID:10925634]
Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary ascarisis: experience of 300 cases. Am J Gastroenterol 1997; 92: 2264-7. [PMID:9399767]
Krige J, Shaw J. Cholangitis and pancreatitis caused by biliary ascariasis. Clin Gastroenteral Hepatol 2009;7(5):A30. [PMID:19138758]
Khuroo MS, Zargar SA, Yattoo GN. Ascaris-induced acute pancreatitis. Br J Surg 1992; 79: 1335-8. [PMID:1486433]
Saowaros V. Endoscopic retrograde cholangio-pancreatographic diagnosis and extraction of massive biliary ascariasis presented with acute pancreatitis: a case report. J Med Assoc Thai 1999; 82: 515-9. [PMID:10443103]
Guelrud M, Herrera I. Acute pancreatitis due to pancreatic duct Ascaris migration after pancreatic sphincterotomy and pancreatic stent placement. Endoscopy 1997; 29: 53. [PMID:9476778]
Asrat T, Rogers N. Acute pancreatitis caused by biliary ascaris in pregnancy. J Perinatol 1995; 15: 330-2. [PMID:8558344]
Morovic-Vergles J, Sabljar-Matovinovic M, Scrbec B. Acute pancreatitis caused by Ascaris lumbricoides in acute renal failure: case report. Lijec Viesn 1995; 117 Suppl 2: 87-8. [PMID:8649171]
Hoffmann H. In vivo and in vitro studies on the sonographical detection of Ascaris lumbricoides. Pediatric radiology 1997; 27: 226-9. [PMID:9126575]
Ferreyra NP, Cerri GG. Ascariasis of the alimentary tract, liver, pancreas and biliary system: its diagnosis by ultrasonography. Hepatogastroenterology 1998; 45: 932-7. [PMID:9755984]
Görgül A, Kayhan B, Ünal S. A case of biliary ascariasis treated medically. Gazi Medical Journal 1995; 6: 187-9. [PMID:14558975]
Shah OJ, Zargar SA, Robbani I. Biliary ascariasis: a review. World J Surg 2006; 30: 1500-6. [PMID:16874446]
Gonzแlez AH, Regalado VC, Van den Ende J. Non-invasive management of Ascaris lumbricoides biliary tact migration: a prospective study in 69 patients from Ecuador. Trop Med Int Health 2001; 6: 146-50. [PMID:11286203]
Wani NA, Shah OJ, Naqash SH. Postoperative biliary ascariasis: presentation and management experience. World J Surg 2000; 24: 1143-5. [PMID:11036295]
Copyright (c) 2014 Pochamana Phisalprapa, Varayu Prachayakul
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.