Ibrarullah Md, Mishra Tapas, Dash Ambika P, Upadhaya U N
Department of Surgery and Surgical Gastroenterology, Hitech Medical College & Hospital, Bhubaneswar - 751010 Orissa, India.
Trop Gastroenterol. 2011 Jul-Sep;32(3):210-3.
This study was undertaken to review the predisposing factors, presentation and management of patients diagnosed with biliary ascariasis while specifically emphasizing the role played by endoscopy.
We performed a retrospective analysis of nine patients diagnosed and admitted with biliary ascariasis at our center. The diagnosis was based on ultrasound findings and confirmed by detection of round worms in the biliary tract or the descending duodenum. The clinical presentation and management were reviewed.
Five of the nine patients had prior biliary sphincter ablative/bypass procedures for choledocholithiasis; including endoscopic sphincterotomy in four and lateral choledochoduodenostomy in one patient. All but one patient presented with acute onset pain abdomen radiating to the back. One patient presented with features of acute cholecystitis. Ultrasound detected the presence of round worms in all the patients. Endoscopic retrograde cholangio-pancreatogram confirmed presence of worm in the biliary tree. Endoscopic extraction of the worm from the biliary tree or duodenum was successfully undertaken in all the patients and provided prompt relief. One patient had recurrence of infection after eight months which was re-treated by endoscopic extraction. Antihelminthics were instituted in all patients.
Biliary ascariasis, should be considered in the differential diagnosis of acute abdomen, particularly in patients who have undergone prior biliary sphincter ablation/bypass procedures like sphincterotomy or choledochoduodenostomy. Ultrasonography is a reliable diagnostic modality. Endoscopic retrograde cholangiogram confirms the diagnosis and precedes endoscopic extraction of the worm. This offers prompt relief from symptoms.
本研究旨在回顾诊断为胆道蛔虫病患者的易感因素、临床表现及治疗，尤其强调内镜检查所起的作用。
我们对在本中心诊断并收治的9例胆道蛔虫病患者进行了回顾性分析。诊断基于超声检查结果，并通过在胆道或十二指肠降部检测到蛔虫得以证实。对临床表现及治疗情况进行了回顾。
9例患者中有5例曾因胆总管结石接受过胆道括约肌消融/旁路手术；其中4例行内镜括约肌切开术，1例行胆总管十二指肠侧侧吻合术。除1例患者外，所有患者均表现为突发腹痛并向背部放射。1例患者有急性胆囊炎的表现。超声检查在所有患者中均检测到蛔虫的存在。内镜逆行胰胆管造影证实胆道内有蛔虫。所有患者均成功通过内镜从胆道或十二指肠取出蛔虫，症状迅速缓解。1例患者在8个月后感染复发，再次通过内镜取出蛔虫进行治疗。所有患者均使用了驱虫药。
在急腹症的鉴别诊断中应考虑胆道蛔虫病，尤其是在曾接受过如括约肌切开术或胆总管十二指肠吻合术等胆道括约肌消融/旁路手术的患者中。超声检查是一种可靠的诊断方法。内镜逆行胆管造影可确诊并在蛔虫内镜取出术前进行。这能迅速缓解症状。
