Pediatric Surgery International

, Volume 22, Issue 2, pp 164–168

Management of hepatobiliary and pancreatic ascariasis in children of an endemic area

Original Article

Abstract

Ascariasis is the most common parasitic infestation in endemic areas and accounts for 50–60% of pediatric admissions in the surgical emergency department. Hepatobiliary and pancreatic ascariasis accounts for about 10% of such admissions. The present study was undertaken to evaluate the clinical features, investigations, and management of hepatobiliary and pancreatic ascariasis. The study was conducted in the endemic areas of Kashmir in northern India over a period of 3 years. During the study period (May 2001 to April 2004), 214 children with hepatobiliary and pancreatic ascariasis were admitted in the department. These children underwent complete clinical evaluation, investigation including ultrasound, and ERCP when required. Surgical intervention was done in patients who failed to settle with medical treatment. Ninety percent of our admissions were from rural areas and 86% of the children presented with pain in the right hypochondrium. Twenty-two percent of patients presented with cholangitis, whereas 39% of the children had mild icterus at presentation. Thirty-eight percent of the children had vomited worms during the episode of illness. Ultrasound was the diagnostic method of choice, which revealed the worms in the CBD in 80% of the patients, and in gall bladder in 16% of the children. Eight patients had worms in the main pancreatic duct while seven (4%) had multiple small liver abscesses. Serum alkaline phosphatase was raised in majority of children (80%). Twenty (9%) children were referred for ERCP. Medical treatment including endoscopic management was successful in 97% of the children. Seven (4%) children had to be operated upon due to complications of the disease. We conclude that the majority of the children with hepatobiliary and pancreatic ascariasis respond to conservative treatment, and surgical treatment is rarely needed.

Keywords

Hepatobiliary Pancreatic ascariasis Children management 

References

  1. 1.
    Hardman JG, Limbird LE, Gilman AG (eds) (2002) Goodman and Gilman’s the pharmacological basis of therapeutics, 10th edn. McGraw-Hill, New York, pp 1122–1137Google Scholar
  2. 2.
    Khuroo MS (1996) Ascariasis. Gastroenterol Clin North Am 25(3):553–577PubMedCrossRefGoogle Scholar
  3. 3.
    Beckingham IJ, Cullis S, Krige J, Bornman P, Terblanche J (1998) Management of hepatobiliary and pancreatic ascariasis infestation in adults after failed medical treatment. B J Surg (selected papers from BJS) 85(7):907–910Google Scholar
  4. 4.
    Rode H, Cullis S, Millar A, Cremin B, Cywes S (1990) Abdominal complications of ascaris lumbricoides in children. Pediatr Surg Int 5:397–401CrossRefGoogle Scholar
  5. 5.
    Khuroo MS, Zargar SA, Mahajan R (1990) Hepatobiliary and pancreatic ascariasis in India. Lancet 335:1503–1506PubMedCrossRefGoogle Scholar
  6. 6.
    Khuroo MS, Mahajan R, Zargar SA, Javid G, Sapru S (1989) Prevalence of biliary tract disease in India: a sonographic study in adult population in India. Gut 30:201–205PubMedCrossRefGoogle Scholar
  7. 7.
    Pawlowski ZS (1990) Ascariaisis. In: Warran KS, Mahmoud AAF (eds) Tropical and geographical medicine, 2nd edn. McGraw-Hill, New York, p 369Google Scholar
  8. 8.
    Wani NA, Chrungoo RK (1992) Biliary ascariasis: surgical aspects. World J Surg 16:976–979PubMedCrossRefGoogle Scholar
  9. 9.
    Cohen S (1980) The sluggish gallbladder of pregnancy. N Engl J Med 302:397–398PubMedCrossRefGoogle Scholar
  10. 10.
    Abe A (1970) The hormonal control and effects of drugs and ions on the electrical and mechanical activity of the uterus. In: Bulbring E, Brading A, Jones A, Tomito T (eds) Smooth muscle. Williams and Wilkins, Baltimore, pp 396–417Google Scholar
  11. 11.
    Somlyo AP, Somlyo AV (1970) Vascular smooth muscle: pharmacology of normal and hypertensive vessels. Pharmacol Rev 22:249–353PubMedGoogle Scholar
  12. 12.
    Schulze K, Christensen J (1977) Lower sphincter of the oppusum esophagus in pseudopregnancy. Gastroenterology 73:1082–1085PubMedGoogle Scholar
  13. 13.
    Fisher RS, Roberts GS, Grabowski CJ, Cohen S (1978) Inhibition of lower esophageal sphincter circular muscle by female sex hormones. Am J Physiol 234:E243–E247PubMedGoogle Scholar
  14. 14.
    Khuroo MS, Zargar SA (1985) Biliary ascariasis: a common cause of biliary and pancreatic disease in an endemic area. Gastroentrology 88:418–423Google Scholar
  15. 15.
    Sun T (1980) Ascariasis. In: Sun T (ed) Pathology and clinical features of parasitic diseases. Masson, New York, pp 115–120Google Scholar
  16. 16.
    Davies MR, Rode H (1982) Biliary ascariasis in children. Prog Pediatr Surg 15:55–74PubMedGoogle Scholar
  17. 17.
    Wright RM, Dorrough TL, Ditmore HB (1963) Ascariasis of the biliary system. Arch Surg 86:402–405PubMedGoogle Scholar
  18. 18.
    Yang SCH, Laube PL (1946) Biliary ascariasis: report of 19 cases. Ann Surg 123:299–303PubMedCrossRefGoogle Scholar
  19. 19.
    Fayez Sandouk, Samir Haffer et al (1997) Pancreatic-biliary ascariasis: experience of 300 cases. Am J Gastroenterol 92:2264–2267Google Scholar
  20. 20.
    Teo TB (1963) A study of gallstones and included worms in recurrent pyogenic cholangitis. J Path Bacteriol 86:123–129CrossRefGoogle Scholar
  21. 21.
    Khuroo MS, Zargar SA, Yatoo GN et al (1992) Ascariasis-induced acute pancreatitis. Br J Surg 79:1335PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Arshad Hussain Malik
    • 1
    • 2
  • B. D. Saima
    • 1
  • M. Y. Wani
    • 1
  1. 1.Department of Paediatric SurgeryShri Maharaja Hari Singh Hospital GMCSrinagarIndia
  2. 2.SrinagarIndia

Personalised recommendations