RESUMEN
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 endoscopic 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.
Asunto(s)
Adenocarcinoma/diagnóstico , Ascariasis/diagnóstico , Ascaris lumbricoides/aislamiento & purificación , Errores Diagnósticos , Granuloma de Células Plasmáticas/diagnóstico , Enfermedades Pancreáticas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Dolor Abdominal/etiología , Albendazol/uso terapéutico , Animales , Antihelmínticos/uso terapéutico , Ascariasis/complicaciones , Ascariasis/tratamiento farmacológico , Ascariasis/cirugía , Diagnóstico Diferencial , Diagnóstico por Imagen , Diarrea/etiología , Granuloma de Células Plasmáticas/complicaciones , Granuloma de Células Plasmáticas/tratamiento farmacológico , Granuloma de Células Plasmáticas/parasitología , Granuloma de Células Plasmáticas/cirugía , Humanos , Linfoma no Hodgkin/complicaciones , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/radioterapia , Linfoma no Hodgkin/cirugía , Masculino , Persona de Mediana Edad , Enfermedades Pancreáticas/complicaciones , Enfermedades Pancreáticas/tratamiento farmacológico , Enfermedades Pancreáticas/parasitología , Enfermedades Pancreáticas/cirugía , Fístula Pancreática/etiología , Pancreaticoduodenectomía , Complicaciones Posoperatorias/etiología , Inducción de Remisión , Procedimientos InnecesariosAsunto(s)
Adenocarcinoma/parasitología , Ascariasis/complicaciones , Ascaris lumbricoides/aislamiento & purificación , Neoplasias Pancreáticas/parasitología , Adenocarcinoma/diagnóstico , Animales , Ascariasis/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/diagnósticoRESUMEN
Fundamento y objetivoLa infección por Ascaris lumbricoides en nuestro medio es anecdótica y suele estar relacionada con viajes a áreas de alta endemicidad como la india y Sudamérica. La afectación biliopancreática por este parásito es infrecuente y una de las complicaciones más temidas. En la literatura científica hay escasas publicaciones acerca de la afectación pancreática en la ascariasis. Presentamos un caso clínico de ascariasis pancreática diagnosticado tras duodenopancreatectomía cefálica por sospecha de adenocarcinoma pancreático.PacienteVarón de 58 años que consulta por un cuadro clínico de dolor abdominal de largo tiempo y diarrea. Se realiza tomografía computarizada, endoscopia, RM y ecoendoscopia con toma de citología por PAAF con resultado anatomopatológico de adenocarcinoma de cabeza pancreática moderadamente diferenciado.ResultadosSe realiza duodenopancreatectomía cefálica. Post-operatorio favorable, destacando fístula pancreática grado B de la ISGPF. El análisis de la pieza evidenció la presencia de un seudotumor pancreático por Ascaris lumbricoides. Tras estos hallazgos se completó el tratamiento con albendazol oral.ConclusionesLa afectación pancreática por ascariasis en nuestro medio es inusual pero es necesario incluirla en el diagnóstico diferencial de tumores y procesos inflamatorios pancreáticos (AU)
Background and aimAscaris 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.PatientA 58-year-old man consulted for longstanding abdominal pain and diarrhea. Computed tomography and magnetic resonance scans, endoscopy, and endoscopic ultrasound-guided fine-needle cytology were performed. The pathological diagnosis was moderately differentiated adenocarcinoma of the pancreatic head.ResultsCephalic 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.ConclusionsPancreatic ascariasis in our environment is unusual, but should be included in the differential diagnosis of tumors and inflammatory processes of the pancreas (AU)