Khuroo M S, Zargar S A
Gastroenterology. 1985 Feb;88(2):418-23.
We prospectively evaluated the incidence, clinical features, radiographic findings, and course of biliary and pancreatic disease caused by ascariasis in an endemic area in India. Ascariasis was an etiologic factor in 40 (36.7%) of the 109 patients studied who had biliary and pancreatic diseases. Disease was prevalent in adult women and was associated with recurrent biliary colic in 38 patients (95%), recurrent pyogenic cholangitis in 27 patients (68%), acalculous cholecystitis in 9 patients (23%), and pancreatic disease in 6 patients (15%). Vomiting of roundworms during biliary colic occurred in 19 patients (48%) and often led to confirmation of biliary ascariasis by direct visualization of the biliary tree. Endoscopic retrograde cholangiopancreatography was an excellent diagnostic tool and often demonstrated worms in the dilated common bile duct and intrahepatic ducts. The worms moved actively into and out of the biliary tree from the duodenum. Thirty-six (90%) patients recovered on symptomatic treatment followed by anthelmintic therapy once acute symptoms subsided. Surgery was needed in 4 patients, as the worms were trapped in the ducts and had led to the formation of common bile duct and intrahepatic duct stones with the worm fragment as the nidus.
我们前瞻性地评估了印度某流行地区蛔虫病所致胆道和胰腺疾病的发病率、临床特征、影像学表现及病程。在所研究的109例患有胆道和胰腺疾病的患者中，蛔虫病是40例（36.7%）的病因。该病在成年女性中较为常见，38例患者（95%）伴有反复发作的胆绞痛，27例患者（68%）伴有反复发作的化脓性胆管炎，9例患者（23%）伴有无结石性胆囊炎，6例患者（15%）伴有胰腺疾病。19例患者（48%）在胆绞痛发作时吐出蛔虫，这常通过直接观察胆道树而确诊为胆道蛔虫病。内镜逆行胰胆管造影是一种很好的诊断工具，常可显示扩张的胆总管和肝内胆管内有蛔虫。蛔虫从十二指肠活跃地进出胆道树。36例（90%）患者在症状治疗后，待急性症状消退后进行驱虫治疗，病情得以恢复。4例患者需要手术治疗，因为蛔虫被困在胆管内，导致以蛔虫碎片为核心形成胆总管和肝内胆管结石。
