Ascariasis in the hepatobiliary system: laparoscopic management

Area of Science:

• Hepatobiliary medicine
• Infectious diseases
• Gastroenterology

Background:

• Ascariasis is a prevalent parasitic infection in developing nations.
• The hepatobiliary system can be invaded by Ascaris, leading to significant symptoms.
• Medical treatments for hepatobiliary ascariasis are frequently ineffective, necessitating interventional procedures.

Purpose of the Study:

• To review and analyze patient data for surgical or endoscopic treatment of hepatobiliary ascariasis.
• To describe treatment algorithms and patient outcomes for this condition.
• To evaluate the efficacy of different intervention techniques.

Main Methods:

• Retrospective chart review of patients treated between February 1992 and February 2007.
• Inclusion criteria: patients undergoing surgical or endoscopic treatment for hepatobiliary ascariasis.
• Data collected: demographics, treatment strategies, and outcomes.

Main Results:

• 13 cases of hepatobiliary ascariasis were treated.
• Common presentations included right upper quadrant abdominal pain.
• Ultrasonography identified parasites in 12 patients; one case discovered during surgery.
• 11 patients had common bile duct involvement, one with cystic duct occlusion.
• Conservative management failed in 12 patients.
• Endoscopic extraction succeeded in 4 patients.
• Surgical interventions included laparoscopic cholecystectomy with common bile duct exploration and T-tube placement (6 patients), common bile duct exploration with primary closure (1 patient), cholecystotomy with cholecystectomy (1 patient), and cholecystectomy with liver abscess drainage (1 patient).

Conclusions:

• Hepatobiliary ascariasis should be considered in the differential diagnosis of upper abdominal pain in at-risk populations.
• Interventional treatment, including endoscopic or laparoscopic approaches, is effective when surgery is indicated.