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Biliary ascariasis--endoscopic aspects. Report of 4 cases
Insights
Retrograde cholangiography effectively diagnosed biliary ascariasis in small children. This method precisely determined roundworm infestation levels and treatment response, aiding management decisions.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Parasitic Infections
Background:
- Biliary ascariasis, a parasitic infection of the bile ducts by roundworms (Ascaris lumbricoides), can cause significant morbidity in children.
- Diagnostic challenges exist in small children, often necessitating invasive procedures.
- Retrograde cholangiography is a standard diagnostic tool for biliary tree abnormalities.
Observation:
- An adult-sized side-viewing fiber-optic duodenoscope was successfully used for retrograde cholangiography in four small children (average weight 12.4 kg) with suspected biliary roundworm infestation.
- Roundworms were directly visualized protruding from the papillary orifice in cases of confirmed infestation.
- Cannulation of the duodenal papilla was demonstrated to be feasible in this pediatric cohort.
Findings:
- Retrograde cholangiography accurately identified the presence and extent of roundworm infestation within the biliary tree.
- The procedure allowed for precise assessment of the response to antiparasitic (vermifuge) therapy.
- Visual confirmation of roundworms facilitated definitive diagnosis.
Implications:
- Retrograde cholangiography is a valuable tool for managing complicated biliary ascariasis in small children.
- This endoscopic technique should be considered in the diagnostic workup, especially when surgical intervention is contemplated.
- It offers a less invasive alternative to exploratory surgery for confirming and assessing biliary parasitic infections.
Abstract:
Retrograde cholangiography was carried out in 4 small children with suspected roundworm infestation of the biliary tree. An adult-sized side-viewing fibre-optic duodenoscope was employed, and a general anaesthetic was given in each case. Roundworms were frequently seen protruding from the papillary orifice when biliary infestation was present. Cannulation of the duodenal papilla was shown to be eminently feasible in these small children, whose average weight was 12,4 kg. The degree of infestation and the response to vermifuge therapy could be determined with precision by retrograde cholangiography. It is suggested that this procedure has a place in the management of the complicated case of biliary ascariasis, and that it should certainly be considered when surgery is contemplated.