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Hepato-biliary ascariasis
HEPATO-BILIARY ASCARIASIS
A
A 17-year-old woman complained of abdominal right upper quadrant pain, fever preceded by chills, and jaundice of about 3 weeks’ duration. She had been in good health previously. At physical examination she looked cachectic, with jaundice, but there was no abdominal tenderness. Her temperature was 39° C. Laboratory findings (normal values in parentheses) included a white blood cell count of 20,000 mm3 (4.5-11.0 × 103 cells /µL [mm3]), hemoglobin 8.7 g/dL (12.0-16.0), AST 32 IU/L (9-48), ALT 39 IU/L (548), and total bilirubin 4.34 mg/dL (0.2-1.0) (direct bilirubin 2.99 mg/dL [0-0.2]). Blood culture was negative. Abdominal US revealed multiple small, nodule-like lesions in both hepatic lobes (A) and a dilated bile duct (11 mm). At ERCP, 8 ascaris worms were seen protruding through the papilla. The bile ducts measured 22 mm in diameter and contained multiple longitudinal filling defects that extended
594
GASTROINTESTINAL ENDOSCOPY
B
into the intrahepatic ducts by retrograde cholangiogram (B). A sphincterotomy was performed and the ascaris worms were removed with a basket. Treatment with intravenous ampicillin and gentamycin as well as piperazine with albendazole was initiated. A second ERCP performed 2 weeks later showed no ascaris worms, although the bile duct was still dilated. The patient was asymptomatic and her hemoglobin had risen to 11 mg/dL but she was still underweight. Jacobo Dib, Jr., MD Alvaro Carvajal, MD Claudia Giannone, MD Carmen Gómez, MD María Bethencourt, MD Alfonso Araujo, MD Caracas, Venezuela doi:10.1067/mge.2000.100773
VOLUME 51, NO. 5, 2000
A
A 17-year-old woman complained of abdominal right upper quadrant pain, fever preceded by chills, and jaundice of about 3 weeks’ duration. She had been in good health previously. At physical examination she looked cachectic, with jaundice, but there was no abdominal tenderness. Her temperature was 39° C. Laboratory findings (normal values in parentheses) included a white blood cell count of 20,000 mm3 (4.5-11.0 × 103 cells /µL [mm3]), hemoglobin 8.7 g/dL (12.0-16.0), AST 32 IU/L (9-48), ALT 39 IU/L (548), and total bilirubin 4.34 mg/dL (0.2-1.0) (direct bilirubin 2.99 mg/dL [0-0.2]). Blood culture was negative. Abdominal US revealed multiple small, nodule-like lesions in both hepatic lobes (A) and a dilated bile duct (11 mm). At ERCP, 8 ascaris worms were seen protruding through the papilla. The bile ducts measured 22 mm in diameter and contained multiple longitudinal filling defects that extended
594
GASTROINTESTINAL ENDOSCOPY
B
into the intrahepatic ducts by retrograde cholangiogram (B). A sphincterotomy was performed and the ascaris worms were removed with a basket. Treatment with intravenous ampicillin and gentamycin as well as piperazine with albendazole was initiated. A second ERCP performed 2 weeks later showed no ascaris worms, although the bile duct was still dilated. The patient was asymptomatic and her hemoglobin had risen to 11 mg/dL but she was still underweight. Jacobo Dib, Jr., MD Alvaro Carvajal, MD Claudia Giannone, MD Carmen Gómez, MD María Bethencourt, MD Alfonso Araujo, MD Caracas, Venezuela doi:10.1067/mge.2000.100773
VOLUME 51, NO. 5, 2000