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.

Ascaris lumbricoides and the surgical complications: our experience from Medical College Hospital.

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.

[Meckel's diverticulitis by ascaris in children: about a case]. / Diverticulite de Meckel d´origine ascaridienne chez l´enfant: à propos d´un cas.

We here report the case of a 4-year-old male child presenting with congenital umbilical bud that, recently, had begun to bleed. Physical examination showed pinkish umbilical bud with blood stains but without any fistula, measuring about 1,5 cm in diameter. Abdominal ultrasound was performed, which suggested urachal sinus. Surgery revealed umbilical bud communicating, in the abdominal portion, with hyperemic, inflammatory Meckel´s diverticulum placed 90 cm away from the ileocaecal angle in which many ascaris were detected. Anatomo-pathological examination of the surgical specimen showed diverticulitis. Thus, the diagnosis of Meckel´s diverticulitis by Ascaris was retained. Resection and anastomosis with bud excision were performed. The postoperative course was simple even after a 6-month follow-up period.

Small bowel obstruction complicating an Ascaris lumbricoides infestation in a 4-year-old male: a case report.

BACKGROUND: Ascariasis is the leading helminthic infection worldwide, with its peak prevalence noted in children aged 2-10 years. Although mainly asymptomatic, chronic and heavy infestation could lead to severe complications such as malnutrition, poor physical and cognitive development, as well as intestinal obstruction. We report the case of a 4-year-old boy with intestinal obstruction due to Ascaris lumbricoides infestation and discuss its public health significance. CASE PRESENTATION: A 4-year-old Black African boy from the Menchum Division in the Northwest Region of Cameroon, with no history of deworming since birth, presented with a 3-day history of generalized abdominal pains, vomiting and obstipation, and abdominal distention evolving over a period of 6 months. Clinical and paraclinical findings were in favor of a subacute intestinal occlusion associated with an electrolyte imbalance. An exploratory laparotomy was done after correction of the electrolyte imbalance. Perioperative findings revealed a dilated small bowel obstructed by bundles of live worms. An enterotomy of 2 cm in length was done, and the bundles of Ascaris lumbricoides worms extracted manually and by milking through the stoma. His postoperative period was unremarkable, and he was discharged on postoperative day 7. He and his entire household were dewormed with a single dose of mebendazole 500 mg administered orally. A follow-up visit 1 week after discharge revealed a healed abdominal wound and normal bowel functions. CONCLUSION: Despite considerable progress made on the control of soil-transmitted helminthiasis in Cameroon, the program faces a number of bottlenecks. Funding is inadequate, making data acquisition and hence remapping of high-risk zones difficult. Accessibility to enclaved zones where most high-risk children live is difficult, while community sensitization on soil-transmitted helminthiasis and proper education on the right environmental hygienic practices are lacking. All these challenges once addressed could go a long way to help achieve recently set sustainable development goals.

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.

Combination of laparoscope and choledochoscope to treat biliary ascariasis: A CARE-compliant case report.

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.

A Case of Biliary Ascariasis in Korea.

Biliary ascariasis is still the leading cause of surgical complication of ascariasis, though its incidence has been dramatically reduced. Herein, we report a case of biliary ascariasis for the purpose of enhancing awareness of parasitic infections as a possible cause. A 72-year-old male visited the emergency room of Dankook University Hospital on 12 July 2015, complaining of right-upper-quadrant pain. By endoscopic retrograde cholangiopancreatography (ERCP), a tubular filling defect in the right hepatic duct was detected. The defect was endoscopically removed and diagnosed as an adult female of Ascaris lumbricoides worm, of 30 cm length. Upon removal of the worm, the pain subsided, and the patient was discharged without any complication. When treating cases of biliary colic, physicians should not neglect biliary ascariasis as the possible cause.

Intrahepatic Duct Stones Harboring Ascariasis Ova: A Case Report.

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.

Biliary ascariasis: an uncommon cause for recurrent biliary colic after biliary sphincterotomy and common bile duct stone removal.

Endoscopic retrograde cholangiography is the most commonly used technique for removal of common bile duct stones. Biliary sphincterotomy during the procedure facilitates stone retrieval from the common bile duct. However, sphincterotomy ablates the normal biliary sphincter mechanism. This facilitates duodeno-biliary reflex and can result in inward migration of luminal parasite into the biliary system. In areas where ascariasis is endemic there is an increased risk of biliary ascariasis in postbiliary sphincterotomy patients. We report an unusual case where a patient presented with recurrent biliary colic after cholecystectomy and common bile duct stone extraction and was diagnosed to have biliary ascariasis with the help of endoscopic ultrasound examination of the biliary system.

Biliary ascariasis in a bile duct stones-removed female patient.

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.

A rare case of abdominal cocoon.

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.

Small bowel histomorphology in surgical complications of ascariasis: a small series.

BACKGROUND: Ascariasis is a worldwide health problem. Patients usually get treated with antihelminthics. Rarely, undiagnosed cases can present with surgical complications. AIM: To study the clinico-pathological characteristics of small bowel specimens of patients presenting with surgical complications of ascariasis. METHODS: This is a retrospective analysis of small bowel specimens of patients presenting with surgical complications of ascariasis from a period of 2010 to 2012, received in our department. RESULTS: The patients were of all age groups and mainly presented with intestinal obstruction and perforation. Transmural gangrenous change was seen in all nine cases. Encysted ova were seen in five cases. Two of the cases showed partial to complete infarction of isolated mesenteric lymph nodes. CONCLUSION: Ascariasis may cause transmural gangrene of bowel as well as mesenteric lymph node infarction.