CASE REPORTS   

Panminerva Medica 2000 September;42(3):227-9

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Bilo-pancreatic Ascaris Lumbricoides infestation. Endoscopic discovery and removal

Brandimarte G., Tursi A. **, Morucci P. *, Gasbarrini G. **

From the Department of Internal Medicine and Digestive Endoscopy Unit *Department of General Surgery ”Cristo Re“ Hospital - Rome, Italy **Department of Internal Medicine Division of Gastroenterology Policlinico “A. Gemelli”, Catholic University, Rome, Italy

Ascaris Lumbricoides infes­ta­tion is rel­a­tive­ly ­rare in indus­tri­al­ized coun­tries, and it ­occurs main­ly in con­di­tions in ­which ­hygiene is lack­ing. We ­describe ­here a ­case of a 39-­year-old ­female ­from ex-Jugoslavia affect­ed by recur­rent hepat­ic col­ic. At ­entry ultra­so­nog­ra­phy ­revealed micro­li­thi­a­sis in the gall­blad­der and wid­en­ing of the pan­creat­ic ­head. The sub­se­quent ­ERCP ­showed ­slight fill­ing ­defects in the cho­led­o­chus and an inflam­ma­tion-­like stric­ture of the papil­la of Vater, and ­after endo­scop­ic sphinc­te­rot­o­my we saw an out­flow of ­dense ­bile and micro­li­thol­its. Thus, a stan­dard sur­gi­cal chol­e­cys­tec­to­my was car­ried out and the ­patient was dis­missed on the 3rd post­op­er­a­tive day with­out any symp­toms. However, the ­patient was admit­ted ­again ­after ­four ­days for a new ­coliky ­pain ­attack. An ­upper endos­co­py ­showed a 23 cm ­long ­mobile par­a­site in the duod­e­num: it was ­caught ­with the poly­pec­to­my ­loap, extract­ed and iden­ti­fied as A. Lumbricoides. The ­patient’s symp­toms dis­ap­peared ­after the endo­scop­ic remov­al of the ­worm and she was dis­missed the day ­after the ­worm’s remov­al. No recur­rence of symp­toms was not­ed dur­ing a 1-­year fol­low-up. This ­case ­showed ­that A. Lumbricoides infes­ta­tion of the bil­iary ­tree ­should be con­sid­ered ­when bil­iary and/or pan­creat­ic symp­toms ­recur, espe­cial­ly in ­patients com­ing ­from unde­vel­oped coun­tries. At the ­same ­time we ­showed ­that endo­scop­ic remov­al is a ­safe and effec­tive treat­ment for ­this infes­ta­tion.