Clinical features and management of biliary ascariasis in a non-endemic area

Biliary ascariasis is common in certain geographical areas of the world. In India, it is common in the Kashmir valley and only stray cases have been r eported from other parts of the country. Between January 1995 and May 1997, 14 patients with biliary ascariasis were seen at our centre, which is more than 1000 km from the Kashmir valley. The mean (+/- SD) age of the patient s was 31.7 (+/- 6.1) years and all were females. None of them had been to a place known to be endemic for biliary ascariasis. Four patients presented with Materials and methods acute cholangitis, eight with acute abdominal pa in and vomiting, and the remaining two were diagnosed incidentally during s urgery for gallstone disease. Barring these two patients, ultrasound examin ation of the abdomen diagnosed the condition accurately. In 10 patients, a part of the worm was visible outside the papilla of Vater. The roundworm wa s caught in a Dormia basket and could be extracted in nine patients. In one patient the worm migrated inside the bile duct while it was being caught i n a Dormia basket. In this and two other patients, in whom the worm had mig rated completely inside the bile duct, worms were removed with the help of a Dormia basket after endoscopic sphincterotomy. There were no complication s of endoscopic therapy. In the two patients in whom biliary ascariasis was detected during surgery, the worms were removed after choledocholithotomy. On a mean follow-up of 13.8 months, only one patient had a recurrence of b iliary ascariasis. It is concluded that biliary ascariasis is not an uncomm on disease and must be considered as a possibility in patients presenting w ith acute cholangitis and biliary pain even in a nonendemic area. Ultrasono graphy is an excellent diagnostic tool and endoscopic management is very ef fective and safe in the treatment of these patients.