Common bile duct worm induced pancreatitis: a rare case report from an urban area
DOI:
https://doi.org/10.18203/2349-2902.isj20205382Keywords:
Ascaris, Pancreatitis, MRCP, ERCP, VermifugeAbstract
Ascaris is the most common intestinal helminth to infest humans in the world. In India, it is endemic to Kashmir and rarely occurs in an urban setting. It has a varied presentation including pancreatitis. Here, we present a case report of a female patient suffering from pancreatitis induced by common bile duct ascariasis in a non-endemic urban area. A 56 year old lady presented with pain upper abdomen and nausea with tenderness in her epigastrium. Contrast enhanced computed tomography was suggestive of pancreatitis. Patient then vomited a worm and further similar history of worm emesis and passage in faeces was elicited. Magnetic resonance cholangiopancreatography showed linear filling defect in distal CBD. 5 live worms were removed via endoscopic retrograde cholangiopancreatography. Vermifuge was started and her follow-up was uneventful. Therefore, there should be a strong suspicion in patients presenting with pancreatitis having a past history or family history of passage of worms in vomits or faeces, even in non-endemic areas.
References
Crompton DW. The prevalence of ascariasis. Parasitol Today. 1988;4(6):162-9.
Bouree P, Barthod F, Chagnon S. Ascaris in gallbladder: report of a case and review. J Egypt Soc Parasitol. 2005;35(2):491-6.
Villamizar E. Ascarislumbricoides infestation as a cause of intestinal obstruction in children: experience with 87 cases. J pediatr Surg. 1996;31: 201-4.
Ascariasis Infection landscapes, 2020. Available at: http://www.infectionlandscapes.org/2011/12/ascariasis.html. Accessed on 25 August 2020.
Wani SA, Ahmad F, Zargar SA, Amin A, Dar ZA, Dar PA. Intestinal helminthiasis in children of Gurez valley of Jammu and Kashmir State, India. J Glob Infect Dis. 2010;2(2):91.
Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet. 1990; 335:1503-6.
CDC ascariasis biology, 2019. Available at: https://www.cdc.gov/parasites/ascariasis/biology.html. Accessed on 25 August 2020.
Khuroo MS, Zargar SA, Yattoo GN, Allai MS, Khan BA, Dar MY, et al. Oddi’s sphincter motor activity in patients with recurrent pyogenic cholangitis. Hepatol. 1993;17:53-8.
Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary ascarisis: experience of 300 cases. Am J Gastroenterol. 1997;92:2264-7.
Masure D, Vlaminck J, Wang T, Chiers K, Van den Broeck W, Vercruysse J, et al. A role for eosinophils in the intestinal immunity against infective Ascaris suum larvae. PLoS Negl Trop Dis. 2013;7(3):e2138.
Ferreyra NP, Cerri GG. Ascariasis of the alimentary tract, liver, pancreas and biliary system: its diagnosis by ultrasonography. Hepatogastroenterol. 1998;45:932-7.
Adam A, Dixon A, Gillard J, Prokop CS, Grainger R. Grainger and Allison's diagnostic radiology. 4th ed. Amsterdam: Elsevier; 2001:1303-4.
Kamath PS, Joseph DC, Chandran R, Rao SR, Prakash MS, D'Cruz AJ. Biliary ascariasis: ultrasonography, endoscopic retrograde cholangiopancreatography, and biliary drainage. Gastroenterol. 1986;91(3):730-2.
Shah OJ, Zargar SA, Robbani I. Biliary ascariasis: a review. World J Surg. 2006;30:1500-6.
Khuroo MS. Ascariasis. Gastroenterol Clin North Am. 1996;25:553-77.
Alam S, Mustafa G, Ahmad N, Khan M. Presentation and endoscopic management of biliary ascariasis. Southeast Asian J Trop Med Public Health. 2007;38(4):631-5.
Algorithm for management of ascaris induced pancreatitis. Available at: http://www.saudijgastro. com/viewimage.asp?img=SaudiJGastroenterol_2007_13_1_25_30462_4.jpg. Accessed on 25 August 2020.
