title: Comparative study on presentation of biliary ascariasis with dead and living worms.
abstract: OBJECTIVE
  Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis (BPA). The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms.
  
  
  METHODS
  We included 138 consecutive cases of BPA that occured during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests.
  
  
  RESULTS
  The age (mean +/- SD) of the patients was 36.8 +/- 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic (131; 94.9%); others were acute cholangitis (30; 21.7%), obstructive jaundice (19; 13.8%), choledocholithiasis (20; 14.5%), acute pancreatitis (10; 7.2%), acute cholecystitis (6; 4.3%), liver abscess (2; 1.4%), hepatolithiasis (3; 2.2%), stricture of common bile duct (2; 1.4%), pancreatic abscess (1; 0.7%) and cirrhosis of liver (1; 0.7%). Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms.
  
  
  CONCLUSIONS
  Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms.
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Shahinul
authors.initials: S
authors.lastname: Alam
authors.forename: Golam
authors.initials: G
authors.lastname: Mustafa
authors.forename: Salimur
authors.initials: S
authors.lastname: Rahman
authors.forename: Shamsul A
authors.initials: SA
authors.lastname: Kabir
authors.forename: Harun O
authors.initials: HO
authors.lastname: Rashid
authors.forename: Mobin
authors.initials: M
authors.lastname: Khan
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D001196:Ascariasis / Q000453:epidemiology* / Q000628:therapy; D001459:Bangladesh / Q000453:epidemiology; D001660:Biliary Tract Diseases / Q000469:parasitology* / Q000628:therapy; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000871:Anthelmintics