CASE 474 Published on 23.05.2000

Teaching Case

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

F. Jelavic-Kojic , G. Simac-Kubat , Z. Sucic , *B. Bakula , *T. Anic

Patient

71 years, female

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Differential Diagnosis List

CBD and left hepatic duct ascariasis

Imaging Findings

The patient lived in northern Croatia. An ultrasound examination diagnosed chronic calculous cholecystitis and choledocholithiasis. An open cholecystectomy and choledocotomy with extraction of common bile duct stones was performed. With the patient feeling well, a T-Tube cholangiogram was performed on the 9th postoperative day.

Discussion

Ascariasis is a well known cause of ac. cholecystitis and cholangitis (1). The diagnosis is often considered when patients with biliary pain come from an area of high prevalence of ascariasis (2,3)although choledocholithiasis alone may be difficult to differentiate from it by ultrasonography(4). In this patient the post-operative cholangiogram demonstrated 2 tubular filling defects, one apparently extruding through the papilla and the other extending into the left hepatic duct. No evidence of worms were seen at surgery, and this therefore represents an incidental postoperative finding(5). The patient was given a 5 day course of Mebendazol and discharged from hospital on the 18th postoperative day after a repeat negative cholangiogram.

References

[1] Akata D, Ozmen MN, Kaya A, Akhan O(1999)Radiological findings of intraparenchymal liver Ascaris (hepatobiliary
ascariasis).Eur Radiol 1999;9(1):93-5. (PMID: 9933388)

[2] Misra SP, Dwivedi M(2000)Clinical features and management of biliary ascariasis in a non-endemic area.Postgrad Med J 2000 Jan;76(891):29-32. (PMID: 10622777)

[3] Botembe N, Cabrera-Alvarez G, Le Moine O, Cremer M(1999)A rare cause of biliary pain in Belgium.Acta Gastroenterol Belg 1999 Oct-Dec;62(4):443-5. (PMID: 10692779)

[4] Misra SP, Awasthy DN, Dwivedi M(1999)Choledocholithiasis mimicking Ascaris lumbricoides: problem in ultrasound
differential diagnosis.
Trop Doct 1999 Apr;29(2):110-1. (PMID: 10418307)

[5] Scheidbach H, Schneider C, Delker-Wegener S, Kockerling F(1999)[Ascaridiasis as an incidental finding after intraoperative cholangiography
during a laparoscopic cholecystectomy].Zentralbl Chir 1999;124(4):344-5. (PMID: 10355091)

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