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Chae H, Suh SW, Choi YS, Sohn HJ, Lee SE, Do JH, Park HJ. Biliary ascariasis misidentified as a biliary stent in a patient undergoing liver resection. PARASITES, HOSTS AND DISEASES 2023; 61:194-197. [PMID: 37258266 DOI: 10.3347/phd.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
Ascaris lumbricoides causes one of the most common soil-transmitted helminthiases globally. The worms mostly infect the human small intestine and elicit negligible or nonspecific symptoms, but there are reports of extraintestinal ectopic ascariasis. We describe a rare case of biliary ascariasis mistaken for biliary stent in a 72-year-old female patient with a history of liver resection. She visited our outpatient clinic complaining of right upper quadrant pain and fever for the past week. She had previously undergone left lateral sectionectomy for recurrent biliary and intrahepatic duct stones 2 years ago. Besides mildly elevated gamma-glutamyl transferase levels, her liver function tests were normal. Magnetic resonance cholangiopancreatography revealed a linear filling defect closely resembling an internal stent from the common bile duct to the right intrahepatic bile duct. A live female A. lumbricoides adult worm was removed by endoscopic retrograde cholangiopancreatography (ERCP). Despite a significant decrease of the ascariasis prevalence in Korea, cases of biliary ascariasis are still occasionally reported. In this study, a additional case of biliary ascariasis, which was radiologically misdiagnosed as the biliary stent, was described in a hepatic resection patient by the worm recovery with ERCP in Korea.
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Affiliation(s)
- Hochang Chae
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea
| | - Suk Won Suh
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea
| | - Yoo Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea
| | - Hee Ju Sohn
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea
| | - Seung Eun Lee
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul 06973, Korea
| | - Jae Hyuk Do
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul 06973, Korea
| | - Hyun Jeong Park
- Department of Radiology, College of Medicine, Chung-Ang University, Seoul 06973, Korea
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Resurgence of intestinal ascariasis among adults: radiological diagnosis and clinical implications. Abdom Radiol (NY) 2022; 47:915-922. [PMID: 35015117 DOI: 10.1007/s00261-022-03407-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/01/2022]
Abstract
To report the radiological features of intestinal ascariasis and to review the clinical implications of this re-emerging disease for adult population of the USA. This retrospective observational study involved 12 adult patients, whose radiological examinations disclosed unsuspected presence of ascaris in their intestinal tract. They were evaluated by computed tomography of the abdomen with oral contrast, small bowel series with barium, and magnetic resonance enterography. This series included 7 men and 5 women, who ranged in age from 19 to 72 years (mean age 48 years). The typical configuration of ascaris within the bowel loops was demonstrated on CT of the abdomen in 5 patients, small bowel examination with barium in 3, and by MR enterography in another 4 cases. Our study highlights the radiological appearances of intestinal ascariasis and the clinical implications of this resurging disease. The practicing radiologists should be aware of these findings, particularly when examining patients who have immigrated from or traveled to the endemic regions.
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Rujeerapaiboon N, Kaewdech A. Massive biliary ascariasis: an unusual cause of acute cholangitis. BMJ Case Rep 2021; 14:e239784. [PMID: 33762275 PMCID: PMC7993313 DOI: 10.1136/bcr-2020-239784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
Acute cholangitis is a condition of bacterial infection following hepatobiliary tract obstruction, which signifies poor prognosis unless adequately drained. The most common cause of bile duct obstruction is choledocholithiasis, in contrast to parasitic infestation, a rare entity causing acute cholangitis nowadays. Therefore, we reported the case of a 68-year-old Thai man who presented with acute fever, intense right upper quadrant abdominal pain and jaundice for 2 days. His medical history was normal except for the history of intermittent biliary colic for a year. Endoscopic retrograde cholangiography was performed and demonstrated multiple, creamy-coloured roundworms coming out from the ampulla of Vater as well as a tubular filling defect in dilated common bile duct from cholangiography. He was diagnosed with acute cholangitis by biliary ascariasis and underwent endoscopic parasitic removal, which subsequently improved symptoms.
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Affiliation(s)
- Natthapat Rujeerapaiboon
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Robbani I, Shah OJ, Shah AA, Ilyas M. Dual Parasitization of the Biliary Tree: First Reported Case. ACG Case Rep J 2019; 6:e00082. [PMID: 31616753 PMCID: PMC6658062 DOI: 10.14309/crj.0000000000000082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/27/2019] [Indexed: 11/17/2022] Open
Abstract
Cases of biliary ascariasis and hydatid cysts in liver and elsewhere are common in endemic areas and are routinely encountered in surgical outpatient departments. We describe the diagnosis and management of a unique case, who presented with manifestations of biliary ascariasis, but on further investigation was found to harbor ascarids as well as ruptured hydatids in his biliary passages. To our knowledge, this is the first reported case of simultaneous parasitization of common bile duct by ascarid and hydatid forms, resulting in obstruction of the biliary system. This report highlights the diversity of presentation and challenges in the management of such cases, when encountered in practice.
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Affiliation(s)
- Irfan Robbani
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Omar Javed Shah
- Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Altaf A Shah
- Department of Medical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
| | - Mohd Ilyas
- Department of Radiodiagnosis, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
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Choi JH, Seo M. A Case of Biliary Ascariasis in Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2017; 55:659-660. [PMID: 29320821 PMCID: PMC5776896 DOI: 10.3347/kjp.2017.55.6.659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/24/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Jun-Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Dankook University Hospital, Cheonan 31116, Korea
| | - Min Seo
- Department of Parasitology and Research Center for Mummy, College of Medicine, Dankook University, Cheonan 31116, Korea
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Chauhan U, Jain N, Kumar Puri S, Garg L, Singh M. Intrahepatic ascariasis – Common parasite at an uncommon site. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sundriyal D, Bansal S, Kumar N, Sharma N. Biliary ascariasis: radiological clue to diagnosis. Oxf Med Case Reports 2015; 2015:246-7. [PMID: 26634136 PMCID: PMC4664850 DOI: 10.1093/omcr/omv026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/01/2015] [Accepted: 03/03/2015] [Indexed: 12/02/2022] Open
Abstract
Ascariasis is caused by Ascaris lumbricoides. It is the most common helminthic infection seen worldwide. Ascariasis is an endemic disease in our country. This is due to the prevailing poor sanitary conditions and low level of education. Biliary ascariasis is an uncommon cause of obstructive jaundice. We report a case of biliary ascariasis in a young labourer who presented with acute abdominal pain.
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology , Dharamshila Hospital & Research Centre , New Delhi , India
| | - Satish Bansal
- Department of Radiology , Dharamshila Hospital & Research Centre , New Delhi , India
| | - Naveen Kumar
- Department of Medicine , PGIMER & Dr RML Hospital , New Delhi , India
| | - Navneet Sharma
- Department of Radiology , Dharamshila Hospital & Research Centre , New Delhi , India
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Laproscopic management of wandering biliary ascariasis. Case Rep Surg 2012; 2012:561563. [PMID: 22973531 PMCID: PMC3437613 DOI: 10.1155/2012/561563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 07/31/2012] [Indexed: 11/20/2022] Open
Abstract
Ascariasis is one of the most common helminthic diseases in humans, occurring mostly in countries with low standards of public health and hygiene, thereby making ascariasis highly endemic in developing countries. In endemic areas, 30% of adults and 60–70% of children harbour the adult worm. Biliary ascariasis is a rare cause of obstructive jaundice. Conventional management involves endoscopic extraction of worm. We are reporting a rare case of ascaris which induced extrahepatic biliary obstruction in a young male who presented with acute cholangitis. The ascaris was removed by laparoscopic exploration of the common bile duct. Postoperative period was uneventful.
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Ding ZX, Yuan JH, Chong V, Zhao DJ, Chen FH, Li YM. 3 T MR cholangiopancreatography appearances of biliary ascariasis. Clin Radiol 2011; 66:275-7. [PMID: 21295208 DOI: 10.1016/j.crad.2010.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/31/2010] [Accepted: 11/08/2010] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the 3 T MR cholangiopancreatography (MRCP) appearances of biliary ascariasis. MATERIALS AND METHODS Nine patients with a MRCP diagnosis of biliary ascariasis were reviewed. All patients had endoscopic retrograde cholangiopancreatography (ERCP) or surgical confirmation of the disease. RESULTS On thin-slab MRCP imaging, Ascaris worms are clearly demarcated within the biliary tree. All the identified worms demonstrated a characteristic three-parallel-lines appearance. The middle high-signal intensity line is sandwiched between two low-signal intensity lines and they are in turn surrounded by high signal bile. On thick-slab MRCP the worms also show the three-line sign but with less clarity. However, thick-slab MRCP has the advantage of providing three-dimensional ERCP-like images of the pancreaticobiliary system. CONCLUSION The "three-line" sign appears to be a characteristic sign of biliary ascariasis on 3 T MRCP.
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Affiliation(s)
- Z X Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Hangzhou, China.
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Sümer A, Tekbaş G. Ultrasonographic Diagnosis of Isolated
Jejunal Ascaris Lumbricoides. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
UNLABELLED AIM/MATERIALS AND METHODS: Between January 2000 and June 2007, 3,548 endoscopic retrograde cholangiopancreatography (ERCP) were performed for extrahepatic cholestasis, cholangitis, and choledocholithiasis. The results of ERCPs were evaluated retrospectively and examined carefully to investigate the management and endoscopic therapy of biliary parasites. RESULTS Of the 3,548 patients who underwent ERCP, 24 (0.66%) were found to have biliary parasitosis. The mean age of the biliary parasitosis patients (16 women) was 48.6 (15-77) years. Of these 24 cases, 16 patients had hydatid cystic disease (eight with partial obstruction of the biliary tract, and eight with ruptured cysts), four patients had Fasciola hepatica, and four patients had Ascaris lumbricoides infestation. Endoscopic sphincterotomy was performed, after which the choledochus was examined carefully by balloon catheter and basket procedure. CONCLUSION The ERCP procedure is very useful in the therapy of biliary parasitic infestations.
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Abstract
A 17-year-old girl presented with features of biliary obstruction. Magnetic resonance cholangi-pancreatography revealed typical linear signals in common bile duct, which appears like Ascaris lumbricoides. The diagnosis was confirmed by endoscopic removal of the worm.
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Affiliation(s)
- Mohammad A Hashmi
- EKO CT and MRI Scan Centre, At Medical College and Hospitals Campus, 88-College Street, Kolkata-700 073, India
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Abstract
In general, gastrointestinal tract is the primary involvement site of parasites during their life cycle. In this article, we will describe amebiasis, ascariasis, and anisakiasis among the many common intestinal parasitic diseases. We will review the epidemiology, life cycles, clinical manifestations and complications, and illustrate detailed imaging findings of intestinal parasites. Recognizing features of parasitic infection is important to establish an early diagnosis that leads to prompt treatment and helps avoid unnecessary surgery.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Abstract
OBJECTIVE Parasites residing in the biliary tree include Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, and Fasciola hepatica. They are willowy, leaf-like, flat flukes dwelling in the bile ducts and gallbladder. Human ascarides, Ascaris lumbricoides, dwelling in the small intestine, inadvertently migrate into the bile ducts and cause biliary obstruction. The purpose of this article is to illustrate typical imaging findings of liver fluke infection and biliary ascariasis. CONCLUSION Adult flukes of Clonorchis and Opisthorchis measure 8-15 mm and adult flukes of Fasciola measure 20-40 mm in length. The presence of flukes in the bile ducts causes dilatation of the bile ducts, varying degrees of chronic inflammation followed by adenomatous hyperplasia, and bile duct wall thickening. Imaging findings of clonorchiasis and opisthorchiasis include visualization of adult flukes in the bile ducts and gallbladder, diffuse dilatation of the peripheral small intrahepatic bile ducts with no or minimal dilatation of the large bile ducts, and thickening of the bile duct wall. In biliary fascioliasis and ascariasis, adult worms are visualized in the dilated bile ducts and gallbladder.
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Affiliation(s)
- Jae Hoon Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-230, South Korea
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