Management of hepatobiliary and pancreatic Ascaris infestation in adults after failed medical treatment.
BACKGROUND
The roles of endoscopy and surgery in the management of Ascaris lumbricoides affecting the hepatobiliary and pancreatic system in adults were determined.


METHODS
All patients undergoing endoscopic retrograde pancreatography for ascariasis of the biliary or pancreatic system unresponsive to standard medical therapy were analysed. Worms were extracted using snare, Dormia basket or biopsy forceps. Success was defined as clearance of worms and eradication of symptoms.


RESULTS
Endoscopic extraction was performed in 25 patients with success in 19. Failures occurred in one patient with Ascaris in the gallbladder, and in five with associated strictures or stones. All six patients were treated successfully by surgery.


CONCLUSIONS
Endoscopy was successful in the treatment of Ascaris infestation resistant to medical therapy in 19 of 25 patients. Surgery remains important in the management of infestations complicated by biliary or pancreatic strictures and stones, or worms in the gallbladder.
Beckingham
I J
IJ
Department of Surgery and the Medical Research Council for Research Centre, University of Cape Town and Groote Schuur Hospital, South Africa.
Cullis
S N
SN
Krige
J E
JE
Bornman
P C
PC
Terblanche
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001196:Ascariasis / Q000601:surgery*; D017164:Ascaris lumbricoides; D001660:Biliary Tract Diseases / Q000188:drug therapy / Q000469:parasitology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008109:Liver Diseases, Parasitic / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000188:drug therapy / Q000469:parasitology / Q000601:surgery*; D017211:Treatment Failure