Biliary ascariasis as a cause of post-cholecystectomy syndrome in an endemic area.
BACKGROUND
Post-cholecystectomy syndrome encompasses numerous biliary, pancreatic and other entities. Biliary ascariasis is a common cause of adult biliary disease in an endemic area. Post-cholecystectomy biliary ascariasis, a cause of post- cholecystectomy syndrome although not yet defined is frequently seen in this part of the world.


METHODS
Between Jan. 1990 and Jan. 2001, 104 cases of post-cholecystectomy biliary ascariasis were seen. Ultrasonography was found to be an excellent tool for diagnosing and monitoring of the worms inside the biliary tract. Endoscopic retrograde cholangiopancreatography had both diagnostic and therapeutic value.


RESULTS
The majority (68.2%) of patients responded to conservative treatment. Surgical treatment was advocated in 18.2%, which included 2 patients with liver abscesses. Endoscopic extraction of worms was successful in 48.2%.


CONCLUSIONS
Post-cholecystectomy biliary ascariasis as a cause of post-cholecystectomy syndrome needs to be included in the list of causes for post-cholecystectomy syndrome. Although the majority of patients respond to conservative treatment but endoscopic extraction or surgical intervention may be needed. Routine deworming of patients undergoing cholecystectomy both preoperatively and postoperatively should be done in all patients in endemic areas of ascariasis. Although this entity is rare in Europe and United States, due to population migration and increased travel, it is necessary for surgeons in these countries to be aware of this condition.
Shah
Omar Javed
OJ
Department of Surgery, Radiodiagnosis and Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India. omarjshah@yahoo.com
Dar
Manzoor Ahmad
MA
Wani
Nazir Ahmad
NA
Robbani
Irfan
I
Zargar
Showkat A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000465:Algorithms; D000871:Anthelmintics / Q000627:therapeutic use; D001196:Ascariasis / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D003137:Common Bile Duct Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000469:parasitology* / Q000628:therapy; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017562:Postcholecystectomy Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000469:parasitology* / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
D000871:Anthelmintics; D015766:Albendazole