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Biliary ascariasis associated with periampullary carcinoma
R Gupta1, A Khanduri, D K Agarwal
1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Summary
A 65-year-old man experienced obstructive jaundice and cholangitis. Investigations revealed biliary ascariasis and a coexistent periampullary carcinoma, highlighting a rare dual diagnosis.
Area of Science:
- Gastroenterology
- Hepatobiliary Medicine
- Parasitology
Background:
- Obstructive jaundice, biliary colic, and recurrent cholangitis are significant clinical presentations requiring thorough investigation.
- Biliary ascariasis, caused by parasitic worms in the bile ducts, can mimic other hepatobiliary pathologies.
- Periampullary carcinoma presents a diagnostic challenge due to its location and potential for varied symptoms.
Observation:
- The patient presented with classic symptoms of biliary obstruction and recurrent infections.
- Sonography demonstrated dilated intrahepatic biliary radicles and common bile duct.
- Intraluminal structures within the bile duct were suggestive of biliary ascariasis.
Findings:
- The diagnostic imaging identified features consistent with biliary ascariasis.
- A coexistent mass was detected at the lower end of the common bile duct and pancreatic region.
- Histopathological examination confirmed the mass as a periampullary carcinoma.
Implications:
- This case underscores the importance of considering parasitic infections in the differential diagnosis of biliary obstruction, even in the presence of malignancy.
- The coexistence of biliary ascariasis and periampullary carcinoma presents a unique clinical scenario with diagnostic and therapeutic challenges.
- Accurate diagnosis is crucial for appropriate management, potentially involving combined treatment strategies for both conditions.