Khuroo Mohammad S, Rather Ajaz A, Khuroo Naira S, Khuroo Mehnaaz S
Mohammad S Khuroo, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190010, India.
World J Gastroenterol. 2016 Sep 7;22(33):7507-17. doi: 10.3748/wjg.v22.i33.7507.
Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36.7%, 23%, 14.5% and 12.5% of all biliary diseases, acute pancreatitis, liver abscesses and biliary lithiasis respectively. Ultrasonography is an excellent diagnostic tool in visualizing worms in gut lumen and ductal system. The rational treatment for HPA is to give appropriate treatment for clinical syndromes along with effective anthelmintic therapy. Endotherapy in HPA is indicated if patients continue to have symptoms on medical therapy or when worms do not move out of ductal lumen by 3 wk or die within the ducts. The worms can be removed from the ductal system in most of the patients and such patients get regression of symptoms of hepatobiliary and pancreatic disease.
1985年，肝胆胰蛔虫病（HPA）在印度克什米尔地区被描述为一种临床病症。HPA是由线虫蛔虫侵入并迁移至胆道和胰管所致。患者表现为胆绞痛、胆管炎、胆囊炎、肝脓肿和急性胰腺炎。蛔虫反复穿过导管，被困住并死亡，导致肝内胆管结石形成。HPA在流行地区普遍存在，在克什米尔这样的一个地区，HPA分别是所有胆道疾病、急性胰腺炎、肝脓肿和胆石症的病因，占比为36.7%、23%、14.5%和12.5%。超声检查是一种很好的诊断工具，可用于观察肠道管腔和导管系统中的蛔虫。HPA的合理治疗方法是针对临床综合征进行适当治疗，并同时进行有效的驱虫治疗。如果患者在药物治疗后仍有症状，或者蛔虫在3周内未从导管腔中排出或在导管内死亡，则需要对HPA进行内镜治疗。大多数患者的蛔虫可从导管系统中清除，此类患者的肝胆胰疾病症状会消退。
