Pancreatic-biliary ascariasis: experience of 300 cases.
BACKGROUND
Infestation with Ascaris lumbricoides is seen worldwide. Recently, there has been much interest in the pancreatic-biliary complications of Ascaris infection. In this study, we present our experience of 300 patients seen in a tertiary referral center.


METHODS
Case charts of patients seen in the Department of Gastroenterology, University of Damascus, Syria, were analyzed, retrospectively, over a 5-yr period (September of 1988 to August of 1993). During this period, 1666 endoscopic retrograde cholangiopancreatographic studies were performed and pancreatic-biliary ascariasis was diagnosed in 300 patients (18%).


RESULTS
The most common presenting symptom was abdominal pain, seen in 98% of patients (294 patients). Complications observed were ascending cholangitis (48 patients; 16%), acute pancreatitis (13 patients; 4.3%), and obstructive jaundice (4 patients; 1.3%). History of worm emesis was present in 25% of patients (76 patients). Most patients (240 patients; 80%) had previously undergone a cholecystectomy or an endoscopic sphincterotomy (232 patients; 77%). Worms were successfully extracted endoscopically in all except two patients, and there were no procedure-related complications.


CONCLUSIONS
In endemic countries, ascariasis should be suspected in patients with pancreatic-biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Endoscopic management results in rapid resolution of symptoms and prevents development of complications.
Sandouk
F
F
Department of Gastroenterology, The University of Damascus, School of Medicine, and Al-Mouassat University Hospital, Syria.
Haffar
S
S
Zada
M M
MM
Graham
D Y
DY
Anand
B S
BS
D015746:Abdominal Pain / Q000469:parasitology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000469:parasitology; D001196:Ascariasis / Q000175:diagnosis* / Q000601:surgery; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000469:parasitology* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000469:parasitology; D002763:Cholecystectomy; D002779:Cholestasis / Q000469:parasitology; D003137:Common Bile Duct Diseases / Q000469:parasitology; D004108:Dilatation, Pathologic / Q000469:parasitology; D019353:Endemic Diseases; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000469:parasitology* / Q000601:surgery; D010183:Pancreatic Ducts / Q000469:parasitology; D010195:Pancreatitis / Q000469:parasitology; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D014839:Vomiting / Q000469:parasitology