title: Ascariasis of the pancreatic duct.
abstract: Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.
authors.affiliation: Vilnius University, Vilnius, Lithuania.
authors.forename: Michail
authors.initials: M
authors.lastname: Klimovskij
authors.affiliation: Vilnius University, Vilnius, Lithuania.
authors.forename: Audrius
authors.initials: A
authors.lastname: Dulskas
authors.affiliation: Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Zita
authors.initials: Z
authors.lastname: Kraulyte
authors.affiliation: Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Saulius
authors.initials: S
authors.lastname: Mikalauskas
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000469:parasitology*; D000368:Aged; D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use*; D001196:Ascariasis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D017164:Ascaris lumbricoides / Q000302:isolation & purification*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000469:parasitology*; D007978:Levamisole / Q000627:therapeutic use*; D010183:Pancreatic Ducts / Q000469:parasitology*; D016896:Treatment Outcome
chemical_list: D000969:Antinematodal Agents; D007978:Levamisole