Gall Bladder Ascariasis: A Rare Entity.

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.

Live ascaris in urinary bladder: a case report.

INTRODUCTION: Ascaris in urinary bladder is an extremely rare phenomenon. It may occur after fistula formation between urinary and gastrointestinal tract or by retrograde migration of adult worm, and is associated with complications. CASE PRESENTATION: A 47-year-old Amhara woman from rural northwest Ethiopia presented with a complaint of difficulty to fully evacuate her bladder of 1 year duration. Ultrasonography showed thickened bladder wall with echo debris. There were also thickened bowel and fluid-filled loops of intestine adjacent to urinary bladder. On cystoscopy examination, there was live ascaris swimming inside the bladder. Enterovesical fistula was entertained and explorative laparotomy performed. Findings confirmed presence of iliovesical fistula. The fistula was divided and the continuity of the intestine restored. The inflammatory mass was subjected to histopathology study and turned out to be benign inflammatory reaction. She was also given antihelminthics. Postoperatively, her course was uneventful, and she was discharged cured. CONCLUSION: Though it is extremely rare to have urinary symptoms from ascariasis, it is important to have a high index of suspicion for all possibilities.

Ascaridiosis en la vía biliar intrahepática: a propósito de un caso pediátrico / Ascariasis in the intrahepatic biliary duct: about a case in pediatrics

El 25 % de la población mundial se encuentra infectada por Ascaris lumbricoides. La ascaridiosis hepatobiliar ocurre en zonas con alta endemicidad y gran carga parasitaria, y genera desde intensa inflamación hasta fibrosis. Se presenta a un paciente de 2 años, que consultó por distensión abdominal y tos de 1 mes de evolución asociada a fiebre en las últimas 72 h. Se realizó una ecografía abdominal que evidenció áscaris en la vía biliar, en el estómago y en el intestino delgado, y una radiografía de tórax con infiltrado inflamatorio intersticial, asociado a hiperleucocitosis con hipereosinofilia y gamma-glutamiltranspeptidasa elevada. Se administró un tratamiento antibiótico, antihelmíntico, sin lograr la eliminación de los parásitos de la vía biliar, por lo que se requirió su extracción mediante colangiografía percutánea

Twenty five percent of the world population is affected by Ascaris lumbricoides. Hepatobiliary ascariasis occurs in areas with high endemicity and great amount of parasitic load, generating intense inflammation to fibrosis. We report a two-year-old patient that consults about abdominal distension and cough of one month of evolution associated with 72 hours of fever. Abdominal ultrasound is performed, which shows bile duct, stomach, small intestine with ascaris and chest x-ray with interstitial inflammatory infiltrate, associated with hyperleukocytosis with hypereosinophilia and elevated gamma-glutamyl transpeptidase. Antibiotic, anthelminthic treatment is administered, without achieving the elimination of the bile duct parasites, requiring their removal by percutaneous cholangiography.

Differential diagnosis of gallbladder ascariasis debris: the added value of contrast enhanced ultrasound with high frequency transducer.

Ascariasis debris of the gallbladder is a very rare incidental or symptomatic presentation. Ascaris debris has a pseudotumorous appearance and may be confused with neoplasia. The aim of the current retrospective study is to investigate the value of contrast enhanced ultrasound (CEUS) for the differential diagnosis of ascariasis debris and neoplasia of the gallbladder. MATERIAL AND METHODS: Conventional B-mode ultrasound (BMUS) and CEUS were performed for solitary echo-rich gallbladder lesions. Analysis of the CEUS enhancement pattern of the lesions was conducted according to the current EFSUMB guidelines. Two radiologists assessed the CEUS enhancement patterns in consensus. The final gold standard was surgery with histological examination or imaging follow-up. RESULTS: A total of 9 patients with final diagnoses of gallbladder ascariasis debris were included. As a control group 26 solitary hyperechoic gallbladder lesions without shadowing were included as a control group. The typical zigzag morphology with multiple echogenic parallel lines without shadow were detected inside the lumen of the gallbladder in 6 patients. After injection of 2.4 ml ultrasound contrast agents, all hyperechoic gallbladder ascariasis debris lesions showed no enhancement. All patients in the control group with similar BMUS morphology showed contrast enhancement. CONCLUSIONS: Real time visualization of contrast enhancement without radiation exposure is one of the main advantages of CEUS over other diagnostic modalities to differentiate ascariasis debris in the gallbladder from enhancing neoplasia. Thus, surgery and other interventions and their complications could be avoided.

Biliary ascariasis presenting with gangrenous perforation of the gall bladder: report of a case and brief review of literature.

The most common cause of gallbladder perforation is calculous cholecystitis. Rarer causes include trauma, iatrogenic injuries, biliary stasis and gall bladder ischemia. We report a case of gall bladder gangrene with perforation, secondary to extensive ascariasis. A 45-year-old woman presented with acute intestinal obstruction and jaundice. She had abdominal distension and right hypochondrial tenderness. Abdominal radiography showed dilated bowel loops and ultrasonogram showed worms in the small intestine and biliary tree. On exploration, a bolus of worms 2 feet proximal to the ileocaecal junction was found causing obstruction. Worms were also present in the bile duct and gallbladder causing gangrene and perforation. She underwent cholecystectomy, bile-duct exploration and enterotomy. However, she died on the third postoperative day of overwhelming sepsis. Enteric complications of ascaris leading to bowel obstruction are well-known. Hepatobiliary complications such as cholangitis and obstructive jaundice are rare. However, such an extreme degree of infestation leading to gangrene and perforation of the gall bladder is extremely rare.

Esophageal Ascariasis with Retrosternal Chest Discomfort.

Ascariasis is one of the most well known helminthic parasite affecting humans. Esophageal asacariasis is extremely rare. We present a case of esophageal ascariasis manifesting as retrosternal chest discomfort.

Ultrasonographic demonstration of inner tube sign: a tropical dilemma.

INTRODUCTION: Ultrasonographic demonstration of intra biliary parallel lines or "inner tube sign" is considered diagnostic for biliary ascariasis in regions where ascariasis is endemic. PATIENTS & METHODS: 148 patients with inner tube sign on ultrasonography were evaluated. In most, diagnosis was confirmed by ultrasonographic demonstration of restitution of normal appearance of bile duct with passage of round worms in vomitus or faeces. RESULTS: Diagnosis was confirmed in 122 of 148 patients. 26 patients were lost to follow-up. Biliary ascariasis was responsible for the sign "parallel lines" in 113 patients. Of the remaining, intrabiliary stents were responsible for the "inner tube sign" in six whereas in three it was due to hydatid membranes following intrabiliary rupture of hydatid cyst. CONCLUSION: Biliary ascariasis is the commonest cause of inner tube sign in the tropics. However, this sign can also be produced by biliary stents and hydatid membranes. Awareness of these possibilities is essential for sonologists in the tropics.

Overlooking the abdominal X-ray --the peril of ascariasis.

A young child presented with intermittent bowel obstruction. The abdominal X-ray was not closely examined, and a contrast study was performed that demonstrated multiple tubular filling defects indicative of worms. The patient was treated accordingly. Reviewing the abdominal X-ray demonstrated numerous serpigenous, tubular, soft-tissue densities in gas-filled bowel loops.

Ascaris Lumbricoides infestation and intestinal MZBCL: a surgical and radiological perspective.

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.

Ascaris through a chest tube: a rare presentation.

A rare case of an Ascaris worm emerging through an intercostal chest tube is reported here because of its unusual presentation. A five-year-old male child had a liver abscess, which had ruptured into the right pleural cavity. An intercostal chest tube was inserted for right pleural effusion. On the 5th postoperative day, a 7 cm long worm was noticed emerging through the chest tube. Ascaris lumbricoides infestation can lead to serious complications because of the mobility of the worms. Though complications such as intestinal obstruction, volvulus, gangrene, pancreatitis, biliary obstruction, cholangiohepatitis, and liver abscess have been reported to occur, intrapleural ascariasis is an extremely rare situation. This report describes a clinical situation of intrapleural ascariasis and emphasizes the importance of remaining aware of this rare complication of ascariasis.

Sonographic findings of ascaris lumbricoides in the gastrointestinal and biliary tracts.

OBJECTIVE: Ascaris lumbricoides may obstruct bowel, biliary tree, pancreatic ducts, and appendix and induce biliary stones. The purpose of this article was to illustrate typical sonographic findings of A. lumbricoides in the gastrointestinal and biliary tracts. METHODS: Clinical data of 57 patients undergoing sonographic examination with confirmed ascariasis were studied retrospectively, and features of sonographic characteristics of A. lumbricoides in gastrointestinal and biliary tracts were studied. RESULTS: Sonographic characteristics of A. lumbricoides were single or multiple echogenic nonshadowing linear, tubular structures; curved strips or rodlike with or without echoic tubular central lines; and a spaghettilike appearance, a target sign, or a pseudotumor appearance in the transverse section. CONCLUSIONS: Ascaris lumbricoides in the gastrointestinal and biliary tracts has various features. Sonographic examination in the diagnosis of ascaridiasis has a high value.

Ascaris lumbricoides-induced acute pancreatitis: diagnosis during EUS for a suspected small pancreatic tumor.

CONTEXT: Ascaris lumbricoides is the second most common intestinal parasite world-wide and, although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. CASE REPORT: We describe the case of a 37-year-old man, with a history of travelling in Eastern countries who presented with Ascaris lumbricoides-induced acute pancreatitis mimicking a small pancreatic cancer, diagnosed during an upper EUS. The endoscopy revealeda roundworm floating in the duodenum; its endoultrasonographic appearance showed a diffuse inhomogeneous pattern, with hypoechoic echotexture, such as in acute pancreatitis. Microbiological examination of the worm revealed a 20 cm long Ascaris lumbricoides. CONCLUSION: In non endemic countries, acute pancreatitis induced by Ascaris lumbricoides is an unusual diagnosis, and should be suspected especially in patients with history of traveling in endemic areas.

[Biliary ascaris-induced obstructive jaundice: a case of acute abdomen]. / Biliyer askariazisin neden oldugu tikanma ikteri: Bir akut karin olgusu.

Ascaris lumbricoides is one of the most common helminthic diseases worldwide and it can cause various complications. The presence of this worm in the biliary tree, however, is a rare condition, especially in children. We describe a child with biliary ascariasis who was presenting clinical symptoms mimicking surgical acute abdomen. The diagnosis was made by ultrasound. The child was successfully treated with mebendazole and anti-spasmolytic. Biliary ascariasis should be added to the differential diagnosis of acute abdominal pain in patients, even in children, from endemic areas.

Presentation and endoscopic management of biliary ascariasis.

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.

Biliary ascariasis: the value of ultrasound in the diagnosis and management.

BACKGROUND: Conventional methods of radiographic examination are often unsatisfactory for identifying worms in the biliary tract. Ultrasonography is a non-invasive, quick and safe procedure known to have diagnostic accuracy. We studied the ultrasonographic appearances of biliary ascariasis and the role of ultrasonography in diagnosis and management. METHODS: In a prospective 5-year study, a sonographic diagnosis of biliary ascariasis was made on 46 Yemeni patients. The diagnosis was based mainly on sonographic appearances supported by clinical and laboratory results and proved by outcome of either surgical or medical management or spontaneous exit of worms. Follow-up ultrasound was performed for all patients to confirm the diagnosis and to monitor management. RESULTS: Parasites were present in the dilated main bile duct in 23 patients, in the gallbladder in 12 patients, in the intrahepatic ducts in 6 patients, in the main pancreatic duct in 4 patients and as an intrahepatic abscess in one patient. The characteristic appearance of Ascaris lumbricoides was as single or multiple echogenic non- shadowing linear or curved strips with or without echoic tubular central lines that represent the digestive tracts of the worm. A spaghetti-like appearance was seen in 9 patients and amorphous fragments were seen in 2 patients. Sixteen patients underwent surgery, 20 patients were treated medically (including spontaneous exit of the worm in 7 patients without treatment) and in 10 patients worms were extracted by endoscopic retrograde cholangiopancreatography. CONCLUSIONS: Follow-up ultrasound was found to be effective in confirming the diagnosis and monitoring management.

Liver lesions of visceral larva migrans due to Ascaris suum infection: CT findings.

The purpose of this study was to analyze computed tomographic (CT) findings of hepatic lesions due to Ascaris suum infection. CT of the liver in three patients, all of whom had immunoserologically confirmed A. suum infection, were retrospectively reviewed. Twenty-five lesions were identified in total. Two radiologists analyzed CT findings in a consensus fashion, with particular interest in the margin, shape, and location of the lesions. Hepatic lesions were ill-defined (22 of 25), small (3-35 mm; average, 11 mm), and nodular (18 of 25) or wedge (three of 25) in shape. Most were located in periportal (16 of 25) or subcapsular (six of 25) regions. Hepatic nodules due to visceral larva migrans of A. suum were located mainly in periportal or subcapsular regions, which may represent periportal eosinophilic granuloma, its pathologic feature. The results were considered to represent the pathophysiology of this entity.

Biliary ascariasis as a cause of post-cholecystectomy syndrome in an endemic area.

BACKGROUND: Post-cholecystectomy syndrome encompasses numerous biliary, pancreatic and other entities. Biliary ascariasis is a common cause of adult biliary disease in an endemic area. Post-cholecystectomy biliary ascariasis, a cause of post- cholecystectomy syndrome although not yet defined is frequently seen in this part of the world. METHOD: Between Jan. 1990 and Jan. 2001, 104 cases of post-cholecystectomy biliary ascariasis were seen. Ultrasonography was found to be an excellent tool for diagnosing and monitoring of the worms inside the biliary tract. Endoscopic retrograde cholangiopancreatography had both diagnostic and therapeutic value. RESULTS: The majority (68.2%) of patients responded to conservative treatment. Surgical treatment was advocated in 18.2%, which included 2 patients with liver abscesses. Endoscopic extraction of worms was successful in 48.2%. CONCLUSION: Post-cholecystectomy biliary ascariasis as a cause of post-cholecystectomy syndrome needs to be included in the list of causes for post-cholecystectomy syndrome. Although the majority of patients respond to conservative treatment but endoscopic extraction or surgical intervention may be needed. Routine deworming of patients undergoing cholecystectomy both preoperatively and postoperatively should be done in all patients in endemic areas of ascariasis. Although this entity is rare in Europe and United States, due to population migration and increased travel, it is necessary for surgeons in these countries to be aware of this condition.