Pancreatic ascariasis with periampullary carcinoma

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Abstract

Ascarias lumbricoides infestation is endemic in tropical countries. Most infections are asymptomatic, but it can produce a wide spectrum of manifestations including hepatobiliary and pancreatic complications. There are reports of association of biliary ascariasis with bilary malignancies in the past, but same is not known for pancreatic ascariasis. We report a case of association of periampullary malignancy with pancreatic ascariasis.

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Hepatobiliary and pancreatic ascariasis in India.

M S Khuroo, R Mahajan, S A Zargar (1990)

500 patients with hepatobiliary and pancreatic disease due to Ascaris lumbricoides infection were studied. 274 patients had duodenal ascariasis, 171 biliary ascariasis, 40 hepatic ascariasis, 8 gall bladder ascariasis, and 7 pancreatic ascariasis. Five clinical presentations were recognised: acute cholecystitis (64 patients), acute cholangitis (121), biliary colic (280), acute pancreatitis (31), and hepatic abscess (4). Ascarides in the duodenum (which were seen to invade only the ampullary orifice) induced either severe biliary colic or episodes of acute pancreatitis. 27 patients had pyogenic cholangitis and were managed by surgical (2) or endoscopic (25) biliary decompression and drainage. Removal of worms from the ampullary orifice and their extraction by mouth led to rapid relief of biliary colic (214 patients) and acute pancreatitis (16). 4 patients died (acute pancreatitis 2, pyogenic cholangitis 1, hepatic abscess 1). In 12 patients worms persisted in the biliary tree at 3 weeks; dead worms were removed from the biliary tree by surgery (5 patients) or with an endoscopic basket (7). Worms moved out of the ductal system in 211 patients. During a mean follow-up of 48 months (SD 14), 76 patients had worm re-invasion of the biliary tree due to ascaris re-infection. Intrahepatic duct and bile duct calculi developed in 7 patients in whom dead worms formed the nidus of stones.

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Hepatobiliary and pancreatic ascariasis

Mohammad S Khuroo, Ajaz A Rather, Naira S Khuroo … (2016)

Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.

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Pancreatic-biliary ascariasis: experience of 300 cases.

I M Zada-Hames, S Haffar, F Sandouk … (1997)

Infestation with Ascaris lumbricoides is seen worldwide. Recently, there has been much interest in the pancreatic-biliary complications of Ascaris infection. In this study, we present our experience of 300 patients seen in a tertiary referral center. Case charts of patients seen in the Department of Gastroenterology, University of Damascus, Syria, were analyzed, retrospectively, over a 5-yr period (September of 1988 to August of 1993). During this period, 1666 endoscopic retrograde cholangiopancreatographic studies were performed and pancreatic-biliary ascariasis was diagnosed in 300 patients (18%). The most common presenting symptom was abdominal pain, seen in 98% of patients (294 patients). Complications observed were ascending cholangitis (48 patients; 16%), acute pancreatitis (13 patients; 4.3%), and obstructive jaundice (4 patients; 1.3%). History of worm emesis was present in 25% of patients (76 patients). Most patients (240 patients; 80%) had previously undergone a cholecystectomy or an endoscopic sphincterotomy (232 patients; 77%). Worms were successfully extracted endoscopically in all except two patients, and there were no procedure-related complications. In endemic countries, ascariasis should be suspected in patients with pancreatic-biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Endoscopic management results in rapid resolution of symptoms and prevents development of complications.

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Journal

Journal ID (nlm-ta): Trop Parasitol

Journal ID (iso-abbrev): Trop Parasitol

Journal ID (publisher-id): TP

Title: Tropical Parasitology

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5070

ISSN (Electronic): 2229-7758

Publication date (Print): Jan-Jun 2015

Volume: 5

Issue: 1

Pages: 55-57

Affiliations

[1] MIOT Advanced Center for GI and Liver Diseases, MIOT International, Chennai, Tamil Nadu, India

[1 ] Department of GI sciences, Christian Medical College, Vellore, Tamil Nadu, India

Author notes

Address for correspondence: Dr. S Arulprakash, Plot No 119, A, First Main Road, Second Cross Street, Lakshmi Nagar Extension, Porur, Chennai - 600 116, Tamil Nadu, India. E-mail: drarulaash@ 123456yahoo.co.in

Article

Publisher ID: TP-5-55

DOI: 10.4103/2229-5070.145590

PMC ID: 4326995

SO-VID: 27bc678d-6f8c-4e1d-868d-361bf8ce5c28

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pancreatic ascariasis with periampullary carcinoma

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Most cited references 10

Hepatobiliary and pancreatic ascariasis in India.

Hepatobiliary and pancreatic ascariasis

Pancreatic-biliary ascariasis: experience of 300 cases.

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