Ascaris lumbricoides Infestation of Bile Ducts: Case Report

Mohammad Saeed Sarwar

Department of Gastroenterology, Madinat Zayed Hospital, AL Dhafra Region, UAE.

Ashraf ALakkad *

Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE.

Hossam Aldin Fawzy

Department of Gastroenterology, Tawam Hospital, Al Ain, UAE.

*Author to whom correspondence should be addressed.


Abstract

Background: Ascariasis is a common helminthic disease that affects the gastrointestinal tract of human beings and is caused by the Ascaris lumbricoid worm. Most of the time, this parasite resides in the intestinal lumen, but it can occasionally travel to the biliary tract through the ampulla of Vater. The most serious and potentially fatal complication of intestinal ascariasis is biliary ascariasis, which can appear in different ways.

Case Report: A non-diabetic, non-alcoholic female reported to the emergency department with a one-day history of abdominal pain and vomiting with worms. The pain began gradually with a score of 7/10 and rapidly deteriorated during the day, reaching 10/10 at the hospital presentation. The patient also had a significant medical history.  Before papillotomy, she underwent endoscopic retrograde cholangiopancreatography with the removal of one common bile duct (CBD) stone, but no stent was implanted. She had her laparoscopic cholecystectomy done as well. Laboratory examination revealed normal liver function tests and C-reactive protein. While abdominal ultrasound confirmed the presence of hepatic pericholangitis and on ultrasound imaging, the CBD was found to be enlarged approximately 7 mm in diameter and had a linear tubular structure with centre faint echogenicity and periphery tubularity. The ultimate diagnosis of the patient was cholangitis brought on by Ascaris lumbricoides. After the diagnosis, endoscopic retrograde cholangiopancreatography showed sphincterotomy with CBD dilation. The worm was extracted by grasping it with biopsy forceps and pulled out of the papilla using a balloon catheter. The length of the worm was 18 centimeters.

Conclusion: Ascaris is the most frequently occurring disease that can cause biliary complications, such as cholangitis.  This case report suggests that cholangitis caused by Ascaris lumbricoides can be successfully treated with the endoscopic approach, indicating that endoscopy could be a viable option to manage ascaris.

Keywords: Ascaris lumbricoides, biliary infestation, ultrasonography, cholangitis, endoscopic retrograde cholangiopancreatography


How to Cite

Sarwar, M. S., ALakkad, A., & Fawzy, H. A. (2022). Ascaris lumbricoides Infestation of Bile Ducts: Case Report. Asian Journal of Research in Medical and Pharmaceutical Sciences, 11(4), 56–61. https://doi.org/10.9734/ajrimps/2022/v11i4202

Downloads

Download data is not yet available.

References

Wang X, Lv YL, Cui SN, Zhu CH, Li Y, Pan YZ. Endoscopic management of biliary ascariasis: A case report. World J Clin Cases. 2021;9(20):5695-700.

Das AK. Hepatic and biliary ascariasis. J Glob Infect Dis. 2014;6(2):65-72.

de Lima Corvino DF, Horrall S. Ascariasis. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 28613547

De Almeida BL, Silva DV, do Rosário MS, Gonçalves BSD, Nunes MG, Ney ALCM, et al. Biliary ascariasis and severe bacterial outcomes: Report of three cases from a pediatric hospital in Brazil. International Journal of Infectious Diseases. 2020;95:115-7.

Uysal E, Dokur M. The helminths causing surgical or endoscopic abdominal intervention: A review article. Iranian Journal of Parasitology. 2017;12(2):156.

Rujeerapaiboon N, Kaewdech A. Massive biliary ascariasis: an unusual cause of acute cholangitis. BMJ Case Reports. 2021;14(3):e239784.

Das AK. Hepatic and biliary ascariasis. Journal of Global Infectious Diseases. 2014;6(2):65.

Karshima SN. Prevalence and distribution of soil-transmitted helminth infections in Nigerian children: a systematic review and meta-analysis. Infectious Diseases of Poverty. 2018;7(04):1-14.

Avokpaho EF, Houngbégnon P, Accrombessi M, Atindégla E, Yard E, Rubin Means A, et al. Factors associated with soil-transmitted helminths infection in Benin: Findings from the DeWorm3 study. PLoS Neglected Tropical Diseases. 2021; 15(8):e0009646.

Kabatende J, Mugisha M, Ntirenganya L, Barry A, Ruberanziza E, Mbonigaba JB, et al. Prevalence, intensity, and correlates of soil-transmitted helminth infections among school children after a decade of preventive chemotherapy in Western Rwanda. Pathogens. 2020;9(12):1076.

Yang D, Yang Y, Wang Y, Yang Y, Dong S, Chen Y, et al. Prevalence and risk factors of Ascaris lumbricoides, Trichuris trichiura and Cryptosporidium infections in elementary school children in Southwestern China: A school-based cross-sectional study. International Journal of Environmental Research and Public Health. 2018;15(9):1809.

Temesgen R, Abebe H, Abera Y. Hepatobiliary and Pancreatic Duct Ascariasis: An Unusual Cause of Obstructive Jaundice and Severe Acute Cholangitis. International Medical Case Reports Journal. 2022;15:281.

Jethwani U, Singh G, Sarangi P, Kandwal V. Laparoscopic management of wandering biliary ascariasis. Case Reports in Surgery. 2012;2012.

Wang Y, Liu J. Biliary ascariasis: particular cause of biliary tract infection. Hepatobiliary Surgery and Nutrition. 2020; 9(1):119.

Azhar M, Sheikh ASF, Khan A, Mustafa S, Shah IA, Hameed B. Hepatobiliary ascariasis complicated by pancreatitis. Journal of Ayub Medical College Abbottabad. 2015;27(2):479-81.

Balasubramanian G. An unusual cause of biliary colic. BMJ Case Rep. 2014; 2014.