Mohamud Abdirahman Ahmed, Dhif Zakariye Dahir, Jubur Abdinasir Artan, Fiidow Osman Abubakar, Bashir Ahmed Muhammad
Department of General Surgery, Mogadishu Somali Turkiye Training and Research Hospital, Mogadishu, Somalia.
Department of General Surgery, Samakaal Hospital, Mogadishu, Somalia.
Int J Surg Case Rep. 2025 Aug;133:111668. doi: 10.1016/j.ijscr.2025.111668. Epub 2025 Jul 11.
Ascariasis is a prevalent parasitic disease in tropical regions, but migration of Ascaris lumbricoides into the gallbladder is an exceptionally rare occurrence due to the anatomical narrowness of the cystic duct. Recognizing such unusual presentations is vital in endemic regions, particularly in patients presenting with symptoms of acalculous cholecystitis.
A 38-year-old female presented with right upper quadrant pain and low-grade fever. Ultrasonography revealed a mobile echogenic structure within the gallbladder, suggestive of Ascaris lumbricoides. Despite empirical antibiotics, persistent symptoms necessitated laparoscopic cholecystectomy. A dead Ascaris worm measuring 13.5 cm was recovered intraoperatively. Postoperative recovery was uneventful, and the patient was prescribed albendazole to prevent reinfection.
Although Ascaris typically resides in the jejunum, migration to the biliary tract can lead to cholecystitis, cholangitis, or pancreatitis. Diagnosis is primarily made via ultrasound. Conservative management is first-line; however, surgical intervention is warranted in cases of persistent symptoms or complications. Eosinophilia may be absent in localized or chronic cases, as seen here.
Gallbladder ascariasis, though rare, should be included in the differential diagnosis of cholecystitis in endemic areas. Timely imaging and appropriate management-whether conservative or surgical-are essential to prevent complications and ensure recovery.
蛔虫病是热带地区常见的寄生虫病，但由于胆囊管解剖结构狭窄，蛔虫迁移至胆囊极为罕见。在流行地区，识别这种不寻常的表现至关重要，尤其是对于出现无结石性胆囊炎症状的患者。
一名38岁女性出现右上腹疼痛和低热。超声检查显示胆囊内有一个可移动的回声结构，提示蛔虫。尽管使用了经验性抗生素，但持续的症状使得腹腔镜胆囊切除术成为必要。术中取出一条长13.5厘米的死蛔虫。术后恢复顺利，并给患者开了阿苯达唑以预防再次感染。
虽然蛔虫通常寄生于空肠，但迁移至胆道可导致胆囊炎、胆管炎或胰腺炎。诊断主要通过超声进行。保守治疗是一线治疗方法；然而，对于持续症状或并发症的病例，手术干预是必要的。如本病例所见，局部或慢性病例可能不存在嗜酸性粒细胞增多。
胆囊蛔虫病虽然罕见，但在流行地区应列入胆囊炎的鉴别诊断。及时的影像学检查和适当的治疗——无论是保守治疗还是手术治疗——对于预防并发症和确保康复至关重要。
