Demessie Abel Girma, Ayalew Suleiman, Negussie Michael A, Bereket G Mariam Masresha, Lake Leaynadis Kassa, Gebrehiwet Cheru Lilay
Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Int J Surg Case Rep. 2024 Dec;125:110536. doi: 10.1016/j.ijscr.2024.110536. Epub 2024 Oct 28.
Biliary ascariasis is a rare complication of Ascaris lumbricoides infestation, often leading to biliary obstruction and cholangitis. Gallbladder perforation secondary to biliary ascariasis is exceedingly uncommon.
A 28-year-old female farmer from a rural area presented with a one-year history of intermittent right upper quadrant pain, worsened by fatty meals. Her symptoms progressed a week before presentation to include fever, jaundice, dark urine, and pruritus. Examination revealed a positive Murphy sign and jaundice, with laboratory results showing leukocytosis and elevated bilirubin. Imaging confirmed biliary ascariasis with choledocholithiasis and ascending cholangitis. Intraoperatively, a sealed perforation of the gallbladder was found alongside a dead Ascaris and multiple stones in the common bile duct (CBD). Surgical intervention included removal of the worms and stones, cholecystectomy and CBD irrigation. Postoperative recovery was uneventful, and the patient was discharged with antihelminthic therapy.
Biliary ascariasis is an infrequent cause of biliary obstruction but can lead to severe complications such as cholangitis and gallbladder perforation. Diagnosis is often clinical, supported by ultrasound and CT imaging. Management involves both medical and surgical approaches, including antibiotics and surgical removal of worms and stones. This case represents a type II gallbladder perforation, as per the Neimeier classification, where an abscess is contained by adhesions.
This case highlights the importance of recognizing parasitic infections as a potential cause of severe biliary complications, particularly in endemic regions.
胆道蛔虫病是蛔虫感染的一种罕见并发症，常导致胆道梗阻和胆管炎。胆道蛔虫病继发胆囊穿孔极为罕见。
一名来自农村地区的28岁女性农民，有一年间歇性右上腹疼痛病史，油腻餐后加重。在就诊前一周，她的症状进展，出现发热、黄疸、深色尿和瘙痒。检查发现墨菲氏征阳性和黄疸，实验室检查结果显示白细胞增多和胆红素升高。影像学检查证实为胆道蛔虫病合并胆总管结石和化脓性胆管炎。术中发现胆囊有一处封闭性穿孔，同时在胆总管内有一条死蛔虫和多个结石。手术干预包括取出蛔虫和结石、胆囊切除术及胆总管冲洗。术后恢复顺利，患者接受抗蠕虫治疗后出院。
胆道蛔虫病是胆道梗阻的少见原因，但可导致胆管炎和胆囊穿孔等严重并发症。诊断通常依靠临床症状，并由超声和CT影像学检查辅助。治疗包括药物和手术方法，如使用抗生素以及手术取出蛔虫和结石。根据奈迈尔分类，该病例属于II型胆囊穿孔，即脓肿被粘连包裹。
该病例凸显了认识到寄生虫感染作为严重胆道并发症潜在病因的重要性，尤其是在流行地区。
