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Biliary Ascariasis in children
J Alam1, M D Wazir, Z Muhammad
1Peads A Unit, Ayub Teaching Hospital, Abbottabad.
Insights
Biliary Ascariasis, a rare complication of common ascariasis, presents with abdominal pain. Ultrasound is effective for diagnosis, and piperazine treatment resolves symptoms quickly.
Area of Science:
- Gastroenterology
- Parasitology
- Pediatrics
Background:
- Ascariasis is highly prevalent in the region.
- Biliary Ascariasis is an uncommon but significant extra-intestinal complication.
Purpose of the Study:
- To investigate the clinical presentation, diagnosis, and management of Biliary Ascariasis.
- To evaluate the utility of ultrasound in diagnosing Biliary Ascariasis.
Main Methods:
- A case series of five patients with Biliary Ascariasis was conducted.
- Clinical evaluation, stool examination, LFTs, CP, and abdominal ultrasound were performed.
- Treatment involved piperazine and spasmolytics, with surgical consultation.
Main Results:
- The most frequent symptom was right upper quadrant abdominal pain.
- Two cases developed complications (cholecystitis, portal empyema) treated with antibiotics.
- All patients improved within 48 hours; ultrasound proved reliable for diagnosis and follow-up.
Conclusions:
- Biliary Ascariasis requires prompt diagnosis and management.
- Piperazine is effective in treating Biliary Ascariasis.
- Ultrasound is a valuable diagnostic tool for Biliary Ascariasis.
Background:
Ascariasis is very common in this part of the world. Biliary Ascariasis is rare but is the commonest extra-intestinal complication.
Methods:
This study was conducted At Ayub Teaching Hospital, Abbottabad, a tertiary care hospital. Five cases of biliary Ascariasis were studied from December 1999 to January 2001. History of passage of worms in stool or vomiting and abdominal pain was taken. After clinical evaluation, Stool Examination, Serum amylase, LFTs, and complete blood picture (CP) were done. Ultrasound abdomen was done as a basic tool for diagnosis. All cases were given Piperazine. Spasmolytics were also given to relax sphincter of oddi to release the worms. Surgical opinions were also taken for each case.
Results:
About 80% Children were above 10 years of age. One case was 1 1/2 years old. Most common symptom was right upper quadrant abdominal pain. Previous history of passage of worms in stool and vomitus was also present. Two children developed complications of Biliary Ascariasis i.e., Cholecystitis and Portal empyema and responded to antibiotics. All children became symptom free in about 48 hours of treatment. Ultrasound was found to be a reliable, non-invasive, and quick tool for diagnosis and follow up.