Biliary ascariasis--role of endoscopic intervention

Area of Science:

• Gastroenterology
• Infectious Diseases
• Hepatobiliary Surgery

Background:

• Biliary ascariasis is a rare condition caused by roundworm infestation of the biliary tract.
• Predisposing factors include prior biliary sphincter ablative/bypass procedures.

Purpose of the Study:

• To review predisposing factors, presentation, and management of biliary ascariasis.
• To emphasize the role of endoscopy in diagnosis and treatment.

Main Methods:

• Retrospective analysis of nine patients with biliary ascariasis.
• Diagnosis confirmed by ultrasound and detection of roundworms.
• Review of clinical presentation and management.

Main Results:

• Five patients had prior biliary sphincter procedures.
• Most patients presented with acute abdominal pain.
• Ultrasound detected roundworms in all patients; endoscopic retrograde cholangiopancreatogram confirmed diagnosis.
• Endoscopic extraction of worms was successful in all patients, providing prompt relief.

Conclusions:

• Biliary ascariasis should be considered in acute abdomen, especially post-biliary surgery.
• Ultrasonography is a reliable diagnostic tool.
• Endoscopic retrograde cholangiopancreatogram and extraction offer effective treatment.