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Guo C, Liu W, Wang Y, Chen T, Xu M. Endoscopic removal of a whole ascaris from the colonic lumen. Endoscopy 2024; 56:E194. [PMID: 38388952 PMCID: PMC10883864 DOI: 10.1055/a-2248-0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Cheng Guo
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Shanghai, China
| | - Wei Liu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Shanghai, China
| | - Yijun Wang
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Shanghai, China
| | - Tao Chen
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Shanghai, China
| | - Meidong Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, Shanghai, China
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2
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Akbar I, Javed Z, Zaib Z. Gall Bladder Ascariasis: A Rare Entity. J Ayub Med Coll Abbottabad 2023; 35:500-502. [PMID: 38404103 DOI: 10.55519/jamc-03-10212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Gall bladder ascariasis is a rare entity accounting for only 2.1% of biliary ascariasis features due to anatomical features of the cystic duct. It usually presents with vague abdominal features. Ultrasonography is the most sensitive and useful investigation for its diagnosis. We present a case of gall bladder ascariasis in an antenatal young female patient showing features of cholecystitis. She was diagnosed by ultrasonography and managed by laparoscopic cholecystectomy followed by oral anti-helminthic drugs. She made an uneventful recovery and is doing great in follow-up visits.
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Affiliation(s)
- Ismail Akbar
- Department of Surgery, Ayub Medical College, Abbottabad, Pakistan
| | - Zanib Javed
- Department of Surgery, Ayub Medical College, Abbottabad, Pakistan
| | - Zainab Zaib
- Department of Surgery, Ayub Medical College, Abbottabad, Pakistan
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3
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Hassan Y, Rather SA, Rather AA, Banday MK. Ascaris lumbricoides and the surgical complications: our experience from Medical College Hospital. Ir J Med Sci 2021; 191:1815-1821. [PMID: 34618299 DOI: 10.1007/s11845-021-02769-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intestinal ascariasis is considered as state subject in our valley of Kashmir. The aim of our study was to analyse the age, clinical presentation, diagnosis, surgical complications, and management of Ascaris lumbricoides in children and adults. METHODS Total of 312 patients above 2 years of age with definite clinical and radiological diagnosis of intestinal ascariasis and associated complications were included in our study. All our patients received anthelminthic drug (Albenzadole 400 mg stat) after termination of acute phase and attached to our Out-Patient Department for follow-up. Each patient was given second dose of antihelminthic drug at second follow-up visit. RESULTS Total of 312 subjects included 131 (41.99%) males and 181 (58.01%) females. The highest number of patients was in age group of 6-10 years (46.47%). Colicky abdomen pain was the most common presentation and present in 80.12% patients followed by vomiting (64.1%). Palpable worm bolus was a cardinal sign present in 46.47% of our subjects. Two-hundred sixty-five (84.94%) patients responded uneventfully and were relieved of colic and obstruction after conservative non-operative treatment. Twenty (6.41%) patients underwent enterotomy and evacuation of worms, 2 (0.64%) subjects underwent resection anastomosis, and 8 (2.56%) patients had laparotomy and milking of worms into colon. None of patient expired during the study period. CONCLUSION Ascaris lumbricoides is common cause of acute abdomen in our valley attributed to poor hygiene and low socioeconomic background. In patients of high clinical suspicion of worm obstruction, prompt investigations should be advised to reach a definitive diagnosis and prevent the development of complications. Significant efforts must be channelised at political and society levels for the prevention of this disease. Mass deworming programs should be adopted to overcome this menace.
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Affiliation(s)
- Yaqoob Hassan
- Department of General and Minimal Access Surgery, SKIMS Medical College, Srinagar, India.
| | | | - Ajaz Ahmad Rather
- Department of General and Minimal Access Surgery, SKIMS Medical College, Srinagar, India
| | - Mohd Kamran Banday
- Department of General and Minimal Access Surgery, SKIMS Medical College, Srinagar, India
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4
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Cai M, Cheng J, Li W, Shuai X, Gao J, Cai K, Wang J, Bai J, Rog C, Wang G, Tao K. Combination of laparoscope and choledochoscope to treat biliary ascariasis: A CARE-compliant case report. Medicine (Baltimore) 2017; 96:e6291. [PMID: 28353561 PMCID: PMC5380245 DOI: 10.1097/md.0000000000006291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Ascariasis is an endemic parasitic disease caused by Ascaris lumbricoides, which severely burdens the healthcare system as well as harms the personal life quality, especially among less developed regions. Biliary ascariasis is a critical complication of intestinal ascariasis with painful and life-threatening manifestations. The exploration of proper strategies as its medical interventions remains largely controversial. PATIENT CONCERNS A 16 year-old patient complained of abdominal pain and yellow sclera. DIAGNOSES Biliary ascariasis INTERVENTIONS:: Laparoscopic cholecystectomy and bile duct exploration. OUTCOMES More than one hundred ascarids were extracted and the patient had been discharged from hospital without any complications. LESSONS The combination of laparoscope and choledochoscope is an efficient method to treat biliary ascariasis, despite of large worm burden in the common bile duct.
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Affiliation(s)
- Ming Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji Cheng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoming Shuai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinbo Gao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiliang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Bai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Colin Rog
- Baylor College of Medicine, Huston, TX
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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Abstract
Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication-hepatolithiasis.A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.
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Affiliation(s)
- Chen-Fang Lee
- From the Department of Liver and Transplantation Surgery (C-FL, W-CL); and Department of Pathology (R-CW, T-CC), Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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6
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Ramzan Z, Anzengruber F. A case of biliary ascariasis. Isr Med Assoc J 2014; 16:324-325. [PMID: 24979844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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7
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Salamone G, Atzeni J, Agrusa A, Gulotta G. A rare case of abdominal cocoon. Ann Ital Chir 2013; 84:S2239253X13021531. [PMID: 24141102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. It manifests by forming a membrane that typically encases the small bowel loops, leading to mechanical obstruction. Preoperative diagnosis is difficult. The etiology of this condition is not well understood; however, it is a form of chronic irritation and inflammation. METHOD A 33 years old male, from Bangladesh, presented to our emergency department complaining of abdominal pain, nausea, and vomiting. CT abdomen shows a picture of intestinal obstruction at the level of the small intestine. Intraoperative findings showed encapsulation of small bowel by a dense whitish membrane as a cocoon. Histological examination showed a granulomatous peritonitis and Ascaris Lumbricoides in the bowel resected. RESULTS AND CONCLUSIONS The preoperative diagnosis of abdominal cocoon is difficult and hence, the diagnosis is usually confirmed by laparotomy. Surgery remains the cornerstone in the management of abdominal cocoon. The pathogenesis of abdominal cocoon remains elusive and has been associated with several conditions. The initial diagnosis of our patient was bowel obstruction from cocoon syndrome (CT and intraoperative findings) probably primitive, and only histologically proved granulomatous peritonitis associated with the presence of the parasite.
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8
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Maheshwari B, Khurana N, Sharma A. Peritoneal ascariasis presenting as granulomatous peritonitis and omental cyst. Trop Gastroenterol 2013; 34:265-267. [PMID: 25046891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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9
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Wang J, Pan YL, Xie Y, Wu KC, Guo XG. Biliary ascariasis in a bile duct stones-removed female patient. World J Gastroenterol 2013; 19:6122-6124. [PMID: 24106417 PMCID: PMC3785638 DOI: 10.3748/wjg.v19.i36.6122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 05/21/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
Biliary ascariasis is a common problem in rural areas in China. The common presentations include biliary colic, acute cholangitis, obstructive jaundice, choledocholithiasis and acute cholecystitis. Here, we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis. A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography. This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.
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10
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Klop KWJ, van Kanten AR. [A young man with parasites during surgery]. Ned Tijdschr Geneeskd 2012; 156:A3223. [PMID: 22357305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An 18-year-old man came to the Emergency Room at the Academic Hospital Paramaribo (Suriname) with a solitary supra-umbilical gunshot-wound. The patient was hypovolemic, with dropping blood pressure and rising pulse, surgery was indicated. After incision of the abdominal midline 1.5 l of blood drained, immediately followed by the appearance of 2 long thin worms. During inspection of the abdominal cavity a perforation of the duodenum and sigmoid and a mesenterial bleeding was seen and treated. Inspection of the small intestine showed presence of Ascaris lumbricoides (roundworm).
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Affiliation(s)
- Karel W J Klop
- Academisch Ziekenhuis, afd. Chirurgie, Paramaribo, Suriname.
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11
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Nikolić H, Palčevski G, Saina G, Peršić M. Chronic intussusception in children caused by Ascaris lumbricoides. Wien Klin Wochenschr 2011; 123:294-6. [PMID: 21499915 DOI: 10.1007/s00508-011-1569-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 01/12/2011] [Indexed: 11/27/2022]
Abstract
Chronic intussusception (CI) is defined as an intussusception lasting for 14 days or more. Because the clinical manifestations are non-specific, the diagnosis is usually delayed. Symptoms include intermittent abdominal pain, sometimes an abdominal mass is palpable and there is a marked weight loss. Diagnosis is based on typical features revealed by ultrasound or barium enema and CT investigations. Therapy is surgical with obligatory exclusion of possible underlying lesions. We report a case of a 3.5-year-old girl with chronic intussusception. Laboratory blood findings revealed sideropenic anemia and stools positive for Ascaris lumbricoides. Anti-parasitic therapy with mebendazole was repeatedly administered with early improvements but soon after symptoms relapsed. During surgery an ileocolic chronic intussusception extending to hepatic flexure was found. Postoperative control examinations proved complete healing. We suspected that Ascaris lumbricoides infestation was an etiologic factor for the development of chronic intussusception in the child.
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Affiliation(s)
- Harry Nikolić
- Department of Pediatric Surgery, University Children's Hospital, Rijeka, Croatia
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12
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Assenza M, Casciani E, Romeo V, Valesini L, Centonze L, Bartolucci P, Ciccarone F, Gualdi G, Modini C. Ascaris Lumbricoides infestation and intestinal MZBCL: a surgical and radiological perspective. Clin Ter 2011; 162:e169-e171. [PMID: 22262337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ascaris Lumbricoides is the most common worm found in human beings and it is the largest of the intestinal nematodes parasitizing humanity. The most common complication of Ascariasis is mechanical bowel obstruction caused by a large number of worms. Bowel obstruction can also be caused by various toxins released by the worms. A large worm bolus can also cause volvulus or intussusception. We report a case of Intestinal Obstruction due to an Ileal MZBCL in an Ascaris. Lumbricoides infestation setting.
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Affiliation(s)
- M Assenza
- Emergency Department of Division of Emergency Surgery and Trauma, Policlinico Umberto I, University Sapienza of Rome, Italy.
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13
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Sadovnikov AA, Panchenko KI, Denisov NV. [Severe complications of nematodoses]. Vestn Khir Im I I Grek 2010; 169:87-89. [PMID: 21400822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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14
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Syam AF. Epigastric pain due to duodenal ascaris infection. Acta Med Indones 2009; 41:94. [PMID: 20355305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Ari Fahrial Syam
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
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15
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Yoo KS, Song HG, Kim KO, Chung YW, Park CH, Hahn T, Park SH, Kim JH, Park CK. Acute pancreatitis due to impaction of Ascaris lumbricoides in the pancreatic duct: case report. Pancreas 2007; 35:290-2. [PMID: 17895856 DOI: 10.1097/mpa.0b013e3180645da5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Alam S, Mustafa G, Ahmad N, Khan M. Presentation and endoscopic management of biliary ascariasis. Southeast Asian J Trop Med Public Health 2007; 38:631-5. [PMID: 17882999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Ascaris lumbricoides is a common parasite and the most serious and dramatic presentation is hepatobiliary and pancreatic ascariasis (HPA). Therefore, this study was planned prospectively to elucidate the clinical presentation of HPA and evaluate the efficacy and safety of endoscopic intervention. In this study we documented 77 consecutive patients with HPA from January 2000 to November 2005. All the patients had endoscopically proven HPA. A total of 77 patients were included in the study. The age ranged from 6 to 80 years, with the third decade most commonly (28.6%) affected. Females were 6 times more likely to be affected than males. The commonest presentation was biliary colic (97.4%); other presentations were acute cholangitis (15.6%), obstructive jaundice (9.1%), acute pancreatitis (6.5%), choledocholithiasis (6.5%), acute cholecystitis (6.5%) and liver abscess (2.6%). In this report 51 (66.2%) had living, 10 (13%) had dead and 16 (20.8%) had both living and dead worms. Choledocholithiasis was associated only with dead worms. From one to 23 worms were found in the biliary tree. In 94.8% of cases we had to remove the worm by wide papillotomy followed by basket extraction. We did not experience any major complications during or following the procedures. Three patients had recurrent HPA during the course of follow-up (1 to 12 months). The majority of patients with HPA presented with biliary colic. This should be kept in mind in the management of an acute abdomen, especially in tropical countries. Endoscopic extraction is a safe and effective procedure for the treatment of HPA.
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Affiliation(s)
- Shahinul Alam
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
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17
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Abstract
BACKGROUND Liver abscess in childhood is a very challenging subject both for patients and doctors. In India, pyogenic liver abscesses have been found mostly in children, especially in rural areas. Liver abscess due to wandering ascarids is a common complication in children in Kashmir, although it is rare outside. METHODS The study was carried over a period of 10 years at Sheri-Kashmir Institute of Medical Sciences Srinagar India. Ten cases of liver abscesses due to wandering ascarids in children were encountered. The children were aged 2 years to 13 years. RESULTS 70% of the children were from rural areas. All ten patients presented with fever, while three patients presented with peritonitis. Ultrasonography was the main tool of diagnosis. All ten patients were managed by open surgical drainage. CONCLUSION We conclude that Ascaris infestation should always be kept in mind while dealing with liver abscess in children.
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Affiliation(s)
- Shamsul Bari
- Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
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Affiliation(s)
- E Zapata
- Dept. of Gastroenterology and Hepatology, Mendaro Hospital, Mendaro, Basque Country, Spain.
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Mercado MA, Borja-Cacho D, Domínguez I, Maravilla EC, Sánchez N, Zavaleta-Martínez E, Ramírez-Muciño A, Barajas-Olivas A, Arceo-Olaiz R. An unusual cause of bilioenteric anastomotic dysfunction after iatrogenic bile duct injury. Ann Hepatol 2006; 5:120-2. [PMID: 16807520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Roux en Y hepatojejunostomy is the surgery of choice for bile duct repair. Anastomotical dysfunction after reconstruction has several etiopathologies. Besides technical factors, ischemia of the duct is responsible for late obstruction. Bile colonization with secondary stones and sludge can also be identified as a cause. An unusual cause of anastomotical dysfunction secondary to ascaris biliary infestation after biliary reconstruction is reported herein. The patient had intermittent cholangitis and eosinophilia. At operation, the worm was found obstructing the anastomosis.
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Affiliation(s)
- Miguel Angel Mercado
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico.
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20
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Moirangthem GS, Singh CA, Lokendra K, Singh LD. Laparoscopic common bile duct exploration for extraction of a round worm. Trop Gastroenterol 2006; 27:169-71. [PMID: 17542295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A 35 years old lady presented with fever, biliary colic, mild jaundice, indigestion and flatulence. The upper abdominal ultrasonography revealed cholecystitis with sludge and a round worm in the common bile duct. Laparoscopic cholecystectomy and exploration of the bile duct for the removal of round worm was performed. The post-operative period was uneventful and the patient was discharged fit on the 4th post-operative day.
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Affiliation(s)
- G S Moirangthem
- Gastroenterology Section, Department of Surgery, Regional Institute of Medical Sciences, Imphal, India.
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21
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Hurtado RM, Sahani DV, Kradin RL. Case records of the Massachusetts General Hospital. Case 9-2006. A 35-year-old woman with recurrent right-upper-quadrant pain. N Engl J Med 2006; 354:1295-303. [PMID: 16554532 DOI: 10.1056/nejmcpc059044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rocío M Hurtado
- Infectious Disease Unit, Massachusetts General Hospital, USA
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Abstract
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.
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Affiliation(s)
- Arshad Hussain Malik
- Department of Paediatric Surgery, Shri Maharaja Hari Singh Hospital GMC, Srinagar, Kashmir, India.
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Agarwal A, Chowdhury V, Srivastava N, Khera G, Singh S. Pancreatic duct ascariasis: sonographic diagnosis--a case report. Trop Gastroenterol 2005; 26:197-8. [PMID: 16737050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We report the case of a 19-year old boy presenting in the emergency with severe epigastric pain whose biochemical tests revealed elevated serum amylase and lipase levels and a clinical diagnosis of acute pancreatitis was made. On ultrasonic examination, the pancreas appeared bulky with a linear tubular echogenic worm (ascaris) seen within the prominent main pancreatic duct. Successful removal of the pancreatic duct worm was achieved through endoscopic retrograde cholangio pancreatography (ERCP).
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Affiliation(s)
- A Agarwal
- Deptt. of Radiodiagnosis, Maulana Azad Medical College & Associated, Lok Nayak Hospital, New Delhi.
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24
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Govindasamy V, Thomson SR. Worms wanted, dead or alive. S Afr Med J 2004; 94:524-5. [PMID: 15285450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Affiliation(s)
- V Govindasamy
- Department of Surgery, Grey's Hospital, Pietermaritzburg
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25
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Ghadimi R, Mohamadnejad M, Mirbagheri SA. Images in medicine. Biliary ascariasis. Hosp Med 2004; 65:307. [PMID: 15230261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
AIM OF THE STUDY To indicate options in a surgical university team in Vietnam for treatment of ascaris-induced acute pancreatitis. PATIENTS AND METHODS From January 1998 to April 2001, 33 patients (mean age 46 years) were admitted with a diagnosis of acute pancreatitis based on elevated serum amylase in 29 patients (88%), and elevated urinary amylase in all patients and a compatible clinical picture. The pancreatic ultrasonography was abnormal in 79% of cases. Biliary and pancreatic ultrasonography shown ascaris in 31 patients (94%). In other two patients ascaris was detected with duodenal endoscopy. RESULTS In 24 patients, the worms from the duodenum and/or across the ampullary orifice was trapped and withdrawn during duodenoscopy and failed in three patients. Nine patients were operated on, three after failure of endoscopic treatment, five for lithiasis of the common bile duct associated to the ascariasis, and one for necrotic pancreatitis. Seven patients operated on underwent a choledocotomy with a T-tube drainage, two patients underwent a left pancreatectomy to withdraw the ascaris, and one patient a resection of pancreatic necrosis. All patients recovered without complications except the patient with a necrotic pancreatitis who developed a pancreatic fistula for 23 days. Mean discharge times were 5.6 days after endoscopic treatment and 12.2 days after surgery. Effective antihelminthic therapy was administered in all patients. CONCLUSION Endoscopic treatment was effective in 24 out of 33 patients. Surgery was indicated for failures of endoscopic treatment, association of ascariasis and common bile duct stones, migration of ascaris in intra pancreatic duct, and pancreatic necrosis.
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Affiliation(s)
- N D Chinh
- Centre hospitalo-universitaire Viet-Duc, 40, Trang-Thi, Hanoi, Vietnam
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27
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Affiliation(s)
- Deepak Amarapurkar
- Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India
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28
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Abstract
Although infestation with Ascaris lumbricoides causes various intestinal complications, massive gastrointestinal bleeding is rare. The authors report on 2 infants who presented with massive hematemesis. In the first patient, a gastroduodenoscopy was performed. Roundworms were found adhering to an oozing duodenal ulcer. Duodenal perforation occurred after extraction of the parasites. The second case was hematemesis together with peritonitis. Exploration found volvulus and a gangrenous segment of the distal ileum. Both infants previously passed roundworms with their stool. The authors conclude that the intestinal ascariasis can be a cause of massive gastrointestinal bleeding, especially in temperate and tropical countries.
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Affiliation(s)
- Surasak Sangkhathat
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hadyai, Songkhla, Thailand
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29
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Xiong PK, Xu DS, Xiong YM. [A case of roundworm in the splenic artery]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2003; 19:324. [PMID: 12572059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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30
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Affiliation(s)
- Eric J Rodriguez
- Department of Radiology, St Joseph's Hospital and Medical Center, Phoenix, Ariz, USA.
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31
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Abstract
Two children with severe bowel sequelae distal to the site of an Ascaris lumbricoides bowel obstruction are reported. It is postulated that these resulted from inflammatory reaction to toxic decomposition products of disintegrating worms. Surgery should be modified in the presence of bowel-wall injury distal to the site of ascarid worm - bolus obstruction.
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Affiliation(s)
- R Steinberg
- Department of Surgery, Red Cross Children's Hospital, University of Cape Town, Rondebosch 7700, Cape Town, South Africa
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32
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Affiliation(s)
- Gregg Miller
- Department of Surgery, San Francisco General Hospital, University of California-San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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33
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Hoi MT, Desjeux A, Bach TT, Barthet M, Grimaud JC. [Endoscopic management of biliary and pancreatic ascariasis in Viet-Nam. Report of a series of 91 cases]. Gastroenterol Clin Biol 2002; 26:968-72. [PMID: 12483126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
AIM Ascariasis is the most widespread helminthiasis in the world. Biliary and pancreatic involvement, frequently encountered in endemic areas, is a serious public health problem. Surgical management is often required. The purpose of our work was to assess the feasibility of emergency endoscopic treatment of biliary and pancreatic ascariasis in the Viet Duc hospital (Hanoi, Vietnam), and to evaluate outcome. METHODS A prospective study conducted over a 3-year period included 91 patients with biliary and pancreatic ascariasis. Diagnosis was based on clinical findings and abdominal ultrasound and was confirmed by endoscopic procedures. RESULTS The 91 patients, 21 males and 70 females, mean age 41 +/- 17 years, underwent endoscopic procedures to retrieve the worm. The procedure was successful in 89 patients (97.8%). Mild pancreatitis occurred in four patients who underwent biliary sphincterotomy. The mean hospital stay was 3.1 days. CONCLUSION Endoscopic management of ascariasis is feasible, with a very low morbidity and a high rate of success. With this treatment, hospital stay is greatly shortened.
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Affiliation(s)
- Mai Thi Hoi
- Service d'Hépato-Gastroentérologie, Hôpital Viet Duc, Hanoi, Viet-nam
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34
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Abstract
A rare case of a 52-year-old woman with empyema of the gallbladder due to ascariasis causing an obstruction in the cystic duct is presented. She was admitted on September 20, 2000, and on September 23 an emergency cholecystectomy was performed. Ultrasonography is a highly sensitive and specific method for diagnosing gallbladder ascariasis, and a cholecystectomy is considered mandatory for the treatment of empyema of the gallbladder.
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Affiliation(s)
- Omar Javed Shah
- Department of Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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35
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Affiliation(s)
- C Ganesh Pai
- Kasturba Medical College, Manipal, Karnataka, India
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36
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Shrivastava UK, Jain N. Biliary stones and ascariasis--our experience. Indian J Physiol Pharmacol 2002; 46:252-4. [PMID: 12500504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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37
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Abstract
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.
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Affiliation(s)
- Toshiaki Kamiya
- Instituto de Gastroenterología, Clínica Kamiya, Christian University of Bolivia, School of Medicine, Santa Cruz
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38
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Affiliation(s)
- P J Mackrell
- Department of Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, Room F-739, 525 E 68th St., New York, NY 10021, USA
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39
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Abstract
Subsequent to preoperative and perioperative indications the common bile duct was explored in 705 patients over a 12-year period, from January 1983 to December 1994. Consequent postoperative T-tube cholangiography revealed the presence of worms in 22 patients. Expulsion of the worms followed T-tube irrigation with 0.9% normal saline in 18 patients. Only one patient had to be reexplored to remove the ascaris. In two patients the worm was removed along with the T-tube, and in one patient the worm came out through the T-tube tract.
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Affiliation(s)
- N A Wani
- Department of General Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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40
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Amog G, Lichtenstein J, Sieber S, El-Fanek H. A case report of ascariasis of the common bile duct in a patient who had undergone cholecystectomy. Arch Pathol Lab Med 2000; 124:1231-2. [PMID: 10923091 DOI: 10.5858/2000-124-1231-acroao] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a case report of ascariasis of the common bile duct in a 65-year-old man from Colombia who had undergone prior cholecystectomy. The patient presented with postprandial epigastric pain and a 20-lb weight loss. The laboratory findings were remarkable for peripheral blood eosinophilia. The ultrasound finding was suggestive of periampullary or pancreatic neoplasm. He underwent endoscopic retrograde cholangiopancreatography with endoscopic extraction of a motile, live worm identified as Ascaris lumbricoides. Roundworm infestation should always be suspected in immigrants from endemic areas who present with hepatobiliary symptoms.
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Affiliation(s)
- G Amog
- Department of Pathology and Laboratory Medicine, Danbury Hospital, CT 06810, USA.
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41
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Yoshihara S, Toyoki Y, Takahashi O, Sasaki M. Laparoscopic treatment for biliary ascariasis. Surg Laparosc Endosc Percutan Tech 2000; 10:103-5. [PMID: 10789583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Biliary ascariasis is one of the most common types of ascaris infections. The current treatments are helminthic drug therapy, endoscopic extraction, and surgical extraction. A case of biliary ascariasis and cholecystocholedocholithiasis was successfully treated by laparoscopic extraction of the living worm and biliary stones. This procedure was found to be very effective for biliary ascariasis with biliary stones, and it holds promise for similar cases in the future.
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Affiliation(s)
- S Yoshihara
- Department of Surgery, Hirosaki University School of Medicine, Japan
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42
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Balasubramaniam M, Sudhakar P, Subhashini M, Srinivasan S, Padma M, Chopra V. Ascaris lumbricoides in the lacrimal passage. Indian J Ophthalmol 2000; 48:53-4. [PMID: 11271938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Ascariasis is caused by the roundworm, Ascaris lumbricoides. We report an additional case of live Ascaris lumbricoides removed from the lacrimal puncta of a 10-year-old boy.
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Affiliation(s)
- M Balasubramaniam
- Department of Ophthalmology, Government Stanley Medical College & Hospital, Chennai-600 001, Tamil Nadu, India
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43
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Abstract
BACKGROUND As many as 1.5 billion people around the world harbour Ascaris lumbricoides in the digestive tract. Gallbladder ascariasis, although less common than bile duct ascariasis, is quite often seen in endemic areas. METHODS Some 1300 patients with hepatobiliary ascariasis, admitted between October 1992 and June 1998, were analysed prospectively. The clinical features and outcome of 56 cases of gallbladder ascariasis are presented. RESULTS Forty-seven patients were diagnosed by ultrasonography and nine were diagnosed at laparotomy. Only ten patients diagnosed by ultrasonography expelled the worms spontaneously, with resolution of symptoms and signs. The remaining 37 patients underwent cholecystectomy. CONCLUSION Gallbladder ascariasis is a significant entity in endemic areas which usually requires cholecystectomy.
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Affiliation(s)
- G Javid
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
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44
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Abstract
The prevalence, symptomatology, and outcome of Ascaris-induced liver abscess was studied prospectively in Kashmir, India, which is an endemic area of ascariasis, from December 1987 to December 1997. Of 510 patients with liver abscess admitted during this period, 74 had biliary ascariasis as the cause (14.51%). Of these 74 patients, 11 had intact ascaridae (live or dead) within the abscess. Six patients had a single abscess, and five had multiple abscesses. Seven patients had associated worms in the bile ducts. Ultrasonography was the main diagnostic procedure used. Ten patients were diagnosed based on clinical and ultrasound findings, and one was diagnosed during laparotomy. Most of the patients were young (age range 3-40 years) with a mean age of 17.20 years. Seven were females, and four were males. Ten patients underwent surgery; nine recovered completely, and one died postoperatively due to septicemia. Another patient died as well: a young child who presented late, was in refractory septic shock following suppurative cholangitis and liver abscess, and could not be taken for surgery. The mortality thus was 9.9%. Liver abscess following invasion of intrahepatic biliary radicles by ascaridae through the ampulla is an unusual complication of an otherwise common disease in Kashmir Valley, affecting children and young adults. The outcome depends on early diagnosis and surgical drainage of the abscess with extraction of worms from the ducts.
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Affiliation(s)
- G Javid
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Post Box 27, Srinagar 19011, Kashmir (J&K), India
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45
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Affiliation(s)
- M K Goenka
- Eko-Endoscopy Centre and Department of Gastroenterology, Institute of Post Graduate Medical Education and Research, Calcutta, India
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46
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Santini M, Baldi A, Vicidomini G, Di Marino MP, Baldi F. Relapsing pneumothorax due to Ascaris lumbricoides larvae. Monaldi Arch Chest Dis 1999; 54:328-9. [PMID: 10546475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
We describe a case of relapsing pneumothorax occurring in a male child aged 11 yrs, resulting from the mechanical inflammatory action of Ascaris lumbricoides larvae localized in the pleuropulmonary tissue. Pulmonary ascariasis should still be considered today in the differential diagnosis of spontaneous pneumothorax occurring in children.
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Affiliation(s)
- M Santini
- Istituto di Chirurgia Toracica, Naples, Italy
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47
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Pidopryhora AP, Pidopryhora IA, Bakaliuk VM, Podlesnyĭ VI. [Obstruction of the common bile duct by an ascarid with the occurrence of suppurative angiocholitis and obstructive jaundice]. Klin Khir 1999:80. [PMID: 10050415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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48
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Beckingham IJ, Cullis SN, Krige JE, Bornman PC, Terblanche J. Management of hepatobiliary and pancreatic Ascaris infestation in adults after failed medical treatment. Br J Surg 1998; 85:907-10. [PMID: 9692561 DOI: 10.1046/j.1365-2168.1998.00764.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The roles of endoscopy and surgery in the management of Ascaris lumbricoides affecting the hepatobiliary and pancreatic system in adults were determined. METHODS All patients undergoing endoscopic retrograde pancreatography for ascariasis of the biliary or pancreatic system unresponsive to standard medical therapy were analysed. Worms were extracted using snare, Dormia basket or biopsy forceps. Success was defined as clearance of worms and eradication of symptoms. RESULTS Endoscopic extraction was performed in 25 patients with success in 19. Failures occurred in one patient with Ascaris in the gallbladder, and in five with associated strictures or stones. All six patients were treated successfully by surgery. CONCLUSION Endoscopy was successful in the treatment of Ascaris infestation resistant to medical therapy in 19 of 25 patients. Surgery remains important in the management of infestations complicated by biliary or pancreatic strictures and stones, or worms in the gallbladder.
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Affiliation(s)
- I J Beckingham
- Department of Surgery and the Medical Research Council for Research Centre, University of Cape Town and Groote Schuur Hospital, South Africa
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49
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Pandit SK. Surgical ascariasis in children. Trop Doct 1998; 28:59. [PMID: 9481209 DOI: 10.1177/004947559802800124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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50
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Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastroenterol 1997; 92:2264-7. [PMID: 9399767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infestation with Ascaris lumbricoides is seen worldwide. Recently, there has been much interest in the pancreatic-biliary complications of Ascaris infection. In this study, we present our experience of 300 patients seen in a tertiary referral center. MATERIALS AND METHODS Case charts of patients seen in the Department of Gastroenterology, University of Damascus, Syria, were analyzed, retrospectively, over a 5-yr period (September of 1988 to August of 1993). During this period, 1666 endoscopic retrograde cholangiopancreatographic studies were performed and pancreatic-biliary ascariasis was diagnosed in 300 patients (18%). RESULTS The most common presenting symptom was abdominal pain, seen in 98% of patients (294 patients). Complications observed were ascending cholangitis (48 patients; 16%), acute pancreatitis (13 patients; 4.3%), and obstructive jaundice (4 patients; 1.3%). History of worm emesis was present in 25% of patients (76 patients). Most patients (240 patients; 80%) had previously undergone a cholecystectomy or an endoscopic sphincterotomy (232 patients; 77%). Worms were successfully extracted endoscopically in all except two patients, and there were no procedure-related complications. CONCLUSIONS In endemic countries, ascariasis should be suspected in patients with pancreatic-biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Endoscopic management results in rapid resolution of symptoms and prevents development of complications.
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Affiliation(s)
- F Sandouk
- Department of Gastroenterology, The University of Damascus, School of Medicine, and Al-Mouassat University Hospital, Syria
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