Journal of Gastrointestinal Infections

Register      Login

VOLUME 2 , ISSUE 1 ( 2012 ) > List of Articles


Hepatobiliary Ascariasis

Deepinder Kaur, Omesh Goyal, Prerna Goyal, Rajdeep Singh, Pooja Suri

Keywords : Ascaris lumbricoides, ERCP, Hepatobiliary ascariasis

Citation Information : Kaur D, Goyal O, Goyal P, Singh R, Suri P. Hepatobiliary Ascariasis. J Gastrointest Infect 2012; 2 (1):17-23.

DOI: 10.5005/jogi-2-1-17

License: CC BY-SA 4.0

Published Online: 01-06-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Ascaris lumbricoides is one of the commonest human parasitic infestations in the developing world. Most of the ascaris infections are asymptomatic and clinical disease ismainly restricted to subjectswith heavywormload. Biliary migration of the wormcan lead to a wide variety of clinical syndromes and concomitant complications necessitating early diagnosis andmanagement. Various disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, cholangitis, biliary strictures and hepatic abscesses. While laboratory tests are non-specific, radiological investigations demonstrate features highly suggestive of biliary ascariasis. The vast majority of patients respond to conservative measures. Endoscopic therapy is necessary in cases which fail to respond to conservative measures or in patients presenting with complicated disease. Worms visible at the ampulla may be extracted endoscopically prior to attempting more intrusive forms of therapy. Sphincterotomy should be avoided for worm extraction since an open biliary sphincter facilitates future disease recurrences should worm reinfestation occur. Recurrence of the disease is frequent due to re-infestations. Wormeradication with anti-helminthic therapy is essential after biliary disease resolution.

PDF Share
  1. Khuroo MS. Ascariasis. Gastroenterol Clin North Am 1996;25(3):553-77.
  2. Ochoa B. Surgical complications of ascariasis. World J Surg 1991;15:222-7.
  3. Lloyd DA. Massive hepatobiliary ascariasis in childhood. Br J Surg 1981;68:468-73.
  4. Gabaldon A, Mofid C, Morishta K, Moskovski S, Sankale M, Standen DD. Control of ascariasis (report of WHO committee). World Health Organ Tech Rep Ser 1967;379:1-39.
  5. Schulman A. Biliary ascariasis presenting in the United States. Am J Gastroenterol 1977;68:167-70.
  6. Al-Karawi MA, Salam I, Mohammed AE. Endoscopic diagnosis and extraction of biliary ascaris: A case report. Ann Saudi Med 1989;9:80-1.
  7. Abu Al-Saud AS. A survey of the pattern of parasitic infestations in Saudi-Arabia. Saudi Med J 1983;4:418-23.
  8. Khuroo MS, Zargar SA, Mahajan R. Hepatobiliary and pancreatic ascariasis in India. Lancet 1990;335:1503-6.
  9. Khuroo MS, Zargar SA. Biliary ascariasis: Acommon cause of biliaryand pancreatic disease in an endemic area. Gastroenterology 1985;88:418-23.
  10. Sandouk F, Haffar S, Zada MM, Graham DY, Anand BS. Pancreatic-biliary ascariasis: Experience of 300 cases. Am J Gastroenterol 1997;92:2264-7.
  11. Yang SC, Laube PJ. Biliary ascariasis-report of 19 cases. Ann Surg 1946;123:299-303.
  12. Leung JW, Chung SC. Endoscopic management of biliary ascariasis. Gastrointest Endosc 1988;34:318-20.
  13. Khuroo MS. Hepatobiliary and pancreatic ascariasis. Indian J Gastroenterol 2001;20(1):C28-32.
  14. Mukhopadhyay M. Biliary Ascariasis in the Indian Subcontinent: A Study of 42 Cases. Saudi J Gastroenterol 2009;15(2):121-4.
  15. Khuroo MS, Zargar SA, Yattoo GN, Dar MY, Javid G, Khan BA, et al. Sonographic findings in gallbladder ascariasis. J Clin Ultrasound 1992;20:587-91.
  16. Gonzalez AH, Regaldo VC, Van den Ende JV. Non-invasive management of Ascaris lumbricoides biliary tract migration: A prospective study in 69 patients from Ecuador. Trop Med Int Health 2001;6:146-50.
  17. Gupta R, Agarwal DK, Choudhuri GD, Saraswat VA, Baijal SS. Biliary ascariasis complicating endoscopic sphincterotomy for choledocholithiasis in India. J Gastroenterol Hepatol 1998;13:1072-3.
  18. Khuroo MS, Mahajan R, Zargar SA, Pathania AGS, Javid G. Biliary and pancreatic ascariasis: a long term follow-up. Natl Med J India 1989;2:4-7.
  19. Langewar DN, Maheshwari MB, Wegholikar UL. Hepatic perforation due to ascariasis. Indian J Pediatr 1993;60:457-9
  20. Schulman A. Ultrasound appearances of intra- and extrahepatic biliary ascariasis. Abdom Imaging 1998;23:60-6.
  21. Schulman A. Intrahepatic biliary stones: Imaging features and a possible relationship with Ascaris lumbricoides. Clin Radiol 1993;47:325-32.
  22. Lim KG, Sellaiah SP. Biliary ascariasis and extrahepatic cholangiocarcinoma: A report of two cases. Singapore Med J 1994;35:400-2.
  23. Gupta R, Khanduri A, Agarwal DK, Sawlani V, Baijal S, Choudhuri G. Biliary ascariasis associated with periampullary carcinoma. Indian J Gastroenterol 1995;14:102-3.
  24. Javid G, Wani NA, Gulzar GM, Khan BA, Shah AH, Shah OJ, et al. Ascaris-induced liver abscess. World J Surg 1999;23:1191- 4.
  25. Paul M. Movements of adult ascaris lumbricoides. Br J Surg 1972;59:437-41.
  26. Kamath PS, Joseph DC, Chandran R, Rao SR, Prakash ML, D’Cruz AJ. Biliary ascariasis: Ultrasonography, endoscopic retrograde cholangiopancreatography and biliary drainage. Gastroenterology 1986;91:730-2.
  27. Ali M, Khan AN. Sonography of hepatobiliary ascariasis. J Clin Ultrasound 1996;24:235-41.
  28. Khuroo MS, Zargar SA, Mahajan R, Bhat RL, Javid G. Sonographic appearances in biliary ascariasis. Gastroenterology 1987;93:267-72.
  29. Khuroo MS, Zargar SA, Yattoo GN, Koul B, Khan BA, Dar MY, et al. Ascaris-induced acute pancreatitis. Am J Surg 1992;79:1335-8.
  30. Schulman A, Loxton AJ, Hegdenrych JJ, Abdulrahaman KE. Sonographic diagnosis of biliary ascariasis. Am J Roentgenol 1982;139:485-9.
  31. Cerri GG, Leite GJ, Simoes JB, Correia Da Rocha DJ, Albuquerque FP, Machado MC, et al. Ultrasonographic evaluation of Ascaris in the biliary tract. Radiology 1983;146:753- 4.
  32. Bhushan B, Watal G, Mahajan R, Khuroo MS. Endoscopic retrograde cholangiopancreatographic features of pancreaticobiliary ascariasis. Gastrointest Radiol 1988;13:327- 30.
  33. Choi TK, Wong J. Severe pancreatitis caused by parasites in the common bile duct. J Trop Med Hyg 1984;87:211-4.
  34. Chen YS, Den BX, Huang BI, Xu LZ. Endoscopic diagnosis and management of Ascaris-induced acute pancreatitis. Endoscopy 1986;18:127-8.
  35. Adaletli I, Selcuk D, Gulsen M, Savas C, Korman U. MRCP findings of biliary ascariasis before and after medical treatment. Turk J Gastroenterol 2005;16:98-101.
  36. Arya PK, Kukreti R, Arya N, Gupta SN. Magnetic resonance of gallbladder ascariasis. Indian J Med Sci 2005;59:208-10.
  37. Pawlowski ZS. Ascariasis. In: Warren KS, Mahmoud AA, editors. Tropical and Geographical Medicine. 2nd ed. USA: Mc Graw Hill; 1995. p. 369-78.
  38. Khuroo MS, Zargar SA, Yattoo GN, Javid G, Dar MY, Boda MI, et al. Wormextraction and biliary drainage in hepatobiliary and pancreatic ascariasis. Gastrointest Endosc 1993;39:680-5.
  39. Zargar SA, Khuroo MS. Therapy of biliary ascariasis and its rationale. Gastroenterology 1987;93:668-9.
  40. Al-Karawi M, Sanai FM, Yasawy MI, Mohammed AE. Biliary strictures and cholangitis secondary to ascariasis: Endoscopic management. Gastrointest Endosc 1999;50:695-7.
  41. El Sheikh Mohamed AR, Al Karawi MA, Yasawy MI. Modern techniques in the diagnosis and treatment of gastrointestinal and biliary tree parasites. Hepatogastroenterology 1991;38:180-8.
  42. Chen YS, Den BX, Huang BI, Xu LZ. Endoscopic diagnosis and management of Ascaris induced acute pancreatitis. Endoscopy 1986;181:27-8.
  43. Kamiya T, Justiniano M, Duran A, Uechi C. Biliopancreatic ascariasis: Endoscopic approach. J Gastroenterol 2002;37:97- 9.
  44. Kamiya T, Morishita T, Reredo R, Marancenbaum C, Montano C. Duodenoscopicmanagement in biliary ascariasis. Dig Endosc 1993;5:179-82.
  45. Sanai FM, Al-Karawi MA. Biliary acsariasis: Report of a complicated case and literature review. Saudi J Gastroenterol 2007;13:25-32.
  46. Sandouk F, Anand BS, Graham DY. The whirlpool jet technique for removal of pancreatic duct ascaris. Gastrointest Endosc 1997;46:180-2.
  47. Smith JW. Anthelmintic drugs. In: Clark WG, Brater DC, Johnson AR, editors. Goth's Medical Pharmacology. 13th ed. St. Louis: Mosby Year Book; 1992. p. 699-703.
  48. Elliott DE. Intestinal Infections by Parasitic Worms. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th edition. Philadelphia: Elsevier; 2010. p. 1921-40.
  49. Wani NA, Shah OJ, Nagash SH. Post-operative biliary ascariasis: Presentation and management - experience. World J Surg 2000;24:1143-5.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.