Surgical manifestations and management of gastrointestinal and hepato-pancreato-biliary ascariasis: an observational study


  • Madhur Anand Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
  • Noor Topno Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
  • Ranendra Hajong Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
  • Arup J. Baruah Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
  • Donkupar Khongwar Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
  • Swati Agarwal Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh, India



Ascariasis, Biliary, Cholangitis, Pancreatic


Background: Ascaris lumbricoides is the largest intestinal nematode parasite of humans. This study describes different presentations and management patterns of gastrointestinal and hepato-pancreato-biliary ascariasis presenting to a tertiary centre of North-eastern India.

Methods: This was a prospective observational study aimed to study the presentations and management patterns of Ascaris related surgical diseases including intestinal obstruction, pancreatitis and cholangitis in a tertiary centre of Northeast India. All consenting cases of gastrointestinal and hepato-pancreato- biliary ascariasis admitted in our hospital were included.

Results: Ninty patients with Ascaris sequeale were included, which included biliary ascariasis without cholangitis: 36, pancreatitis: 30, cholangitis: 18 and sub-acute intestinal obstruction: 6. Ultrasound was the most useful diagnostic investigation followed by stool examination and endoscopy. Hepato-pancreato-biliary ascariasis was managed conservatively and the progress monitored with sonography. The surgical management choledocho-duodenostomy was done for three patients having biliary ascariasis with unresolving obstructive jaundice and recurrent cholangitis on conservative management and 6 patients underwent therapeutic endoscopic worm removal. There were no deaths. No patient needed ICU care.

Conclusions: Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Hepato-pancreato-biliary ascariasis can be managed conservatively for majority of the patients.


Khuroo MS, Rather AA, Khuroo NS, Khuroo MS. Hepatobiliary and pancreatic ascariasis. World J Gastroenterol. 2016; 22 (33):7507-17.

Wani MY, Chechak BA, Reshi F, Pandita S, Rather MH, Sheikh TA, et al. Our experience of biliary ascariasis in children. J Indian Assoc Ped Surg. 2006;11(3):129-32.

Baba AA, Shera AH, Bhat MA, Hakim S, Sheikh KA, Shah OJ. Management of biliary ascariasis in children living in an endemic area. Eur J Pediatr Surg. 2010;20(3):187-90.

Mukhopadhyay M. Biliary ascariasis in the Indian subcontinent: a study of 42 cases. Saudi J Gastroenterol 2009;15(2):121-4.

Khuroo MS, Mahajan R, Zargar SA, Javid G, Sapru S. Prevalence of biliary tract disease in India: A sonographic study in adult population in Kashmir. Gut. 1989;30:201-5.

Khuroo MS, Zargar SA. Biliary ascariasis. A common cause of biliary and pancreatic disease in an endemic area. Gastroenterology. 1985;88:418-23.

Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet. 1990;335(8704):1503-6.

Das AK. Hepatic and biliary ascariasis. J Glob Infect Dis. 2014;6(2):65-72.

Gonzalez AH, Regaldo VC, Van den Ende JV. Non-invasive management of Ascaris lumbricoides biliary tract migration: a prospective study in 69 patients from Ecuador. Trop Med Int Health. 2001;6:146-50.

Khuroo MS, Zargar SA, Yattoo GN, Javid G, Dar MY, Boda MI, et al. Worm extraction and biliary drainage in hepatobiliary and pancreatic ascariasis. Gastrointest Endosc. 1993;39:680-5.

Zargar SA, Khuroo MS. Therapy of biliary ascariasis and its rationale. Gastroenterology. 1987;93:668-9.

Al-Karawi M, Sanai FM, Yasawy MI, Mohammed AE. Biliary strictures and cholangitis secondary to ascariasis: Endoscopic management. Gastrointest Endosc. 1999;50:695-7.

El Sheikh Mohamed AR, Al Karawi MA, Yasawy MI. Modern techniques in the diagnosis and treatment of gastrointestinal and biliary tree parasites. Hepatogastroenterology. 1991;38:180-8.

Chen YS, Den BX, Huang BI, Xu LZ. Endoscopic diagnosis and management of ascaris induced acute pancreatitis. Endoscopy. 1986;181:27-8.

Kamiya T, Justiniano M, Duran A, Uechi C. Biliopancreatic ascariasis: Endoscopic approach. J Gastroenterol. 2002;37:97-9.

Sanai FM, Al-Karawi MA. Biliary acsariasis: Report of a complicated case and literature review. Saudi J Gastroenterol. 2007;13:25-32.

Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastroenterol. 1997;92:2264-7.






Original Research Articles