Ascaris-induced liver abscess

The prevalence, symptomatology, and outcome of Ascaris-induced liver absces s was studied prospectively in Kashmir, India, which is an endemic area of ascariasis, from December 1987 to December 1997. Of 510 patients with liver abscess admitted during this period, 74 had biliary ascariasis as the caus e (14.51%), Of these 74 patients, 11 had intact ascaridae (live or dead) wi thin the abscess, Six patients had a single abscess, and five had multiple abscesses. Seven patients had associated worms in the bile ducts. Ultrasono graphy was the main diagnostic procedure used. Ten patients were diagnosed based on clinical and ultrasound findings, and one was diagnosed during lap arotomy. Most of the patients were young (age range 3-40 years) with a mean age of 17.20 years. Seven were females, and four were males, Ten patients underwent surgery; nine recovered completely, and one died postoperatively due to septicemia. Another patient died as well: a young child who presente d late, was in refractory septic shock following suppurative cholangitis an d liver abscess, and could not be taken for surgery. The mortality thus was 9.9%. Liver abscess following invasion of intrahepatic biliary radicles by ascaridae through the ampulla is an unusual complication of an otherwise c ommon disease in Kashmir Valley, affecting children and young adults, The o utcome depends on early diagnosis and surgical drainage of the abscess with extraction of worms from the ducts.